B. Mozes et al., FACTORS AFFECTING CHANGE IN QUALITY-OF-LIFE AFTER PROSTATECTOMY FOR BENIGN PROSTATIC HYPERTROPHY - THE IMPACT OF SURGICAL TECHNIQUES, The Journal of urology, 155(1), 1996, pp. 191-196
Purpose: The impact of prostatectomy on quality of life was assessed i
n patients with benign prostatic hypertrophy (BPH) who were classified
according to the expected benefit from surgical intervention. The rel
ative impact of the 2 surgical techniques (open versus closed) on shor
t-term quality of life was compared. Materials and Methods: An observa
tional study was done on 545 consecutive patients with BPH undergoing
prostatectomy at 3 medical centers in Israel between 1991 and 1992. Re
peated structured interviews preoperatively, and at 4 and 12 months po
stoperatively were performed, including 6 quality of life questionnair
es evaluating BPH specific (symptom severity and symptom effect) and g
eneric (activity, independence, mental health and health perception) p
arameters. In addition, the interviews consisted of socio-demographic
data elements. Clinical details regarding severity of prostatic diseas
e and co-morbidity were obtained from the medical charts. Results: We
found a correlation between postoperative change in symptom effect and
in generic quality of life measures (r-0.11 to 0.20, p <0.04). The po
stoperative decrease in the mean symptom effect score was 56% and 52%
for severe and moderate preoperative levels, respectively. There was n
o decrease in the mean symptom effect score for the mild preoperative
level(18% of these patients had postoperative deterioration). A second
ary operation, and the combination of diabetes mellitus and poor activ
ity level were risk factors for lack of improvement in patients with m
oderate preoperative symptom effects. We found that the impact of open
prostatectomy on quality of life was similar to that of the closed te
chnique after adjustment for patient attributes, except for those with
an indwelling urinary catheter in whom an open operation was advantag
eous. Conclusions: In patients with BPH and mild symptom effects, and
in subgroups of patients with moderate symptom effects surgery should
not be recommended. Based on short-term measures of quality of life th
ere is no justification for a preference between open and closed opera
tions.