Long-term incidence of acute myocardial, infarction after open and transurethral resection of the prostate for benign prostatic hyperplasia

Purpose: Acute myocardial infarction was found to be the main cause of incr eased long-term mortality in patients after transurethral compared to open prostatectomy in various retrospective studies. We performed a randomized p rospective study to compare morbidity and incidence of acute myocardial inf arction in patients after transurethral compared to open prostatectomy for benign prostatic hyperplasia. Materials and Methods: We studied 365 patients who were assigned to transur ethral (236) or open (129) prostatectomy only according to the size of the prostate and who were followed for 7 to 8 years. The clinical status of the patients in both groups before and after the operation was compared, and t he rate of myocardial infarction and long-term mortality was studied. Results: More patients with a history of cerebrovascular accident (5.4 vers us 0.8%) and indwelling catheters (16.3 versus 7.6%) before the operation w ere in the open prostatectomy group. Among the 236 patients operated on tra nsurethrally 31 were reoperated on (6 more than once) during followup compa red to 4 of the 129 patients who underwent open prostatectomy. In 15 patien ts from the transurethral prostatectomy group myocardial infarction develop ed compared to 9 patients in the open prostatectomy group. This difference was not statistically significant. The rate of acute myocardial infarction after prostatectomy, no matter which approach was used, was greater than 6% and it appeared to be higher when compared to the rate of infarction in th e general population of the same age group, which is approximately 2.5% in our county. There was no statistically significant difference in the overal l mortality rate between the transurethral and open prostatectomy groups, w hich was 14.4 and 8.5% respectively. Conclusions: Open prostatectomy is more effective in overcoming urinary obs truction than the transurethral approach. No significant differences in myo cardial infarction or overall mortality rates were found between the 2 grou ps.