5-YEAR OUTCOME OF SURGICAL RESECTION AND WATCHFUL WAITING FOR MEN WITH MODERATELY SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA - A DEPARTMENT-OF-VETERANS-AFFAIRS COOPERATIVE STUDY

Purpose: We determine outcomes after 5 years of followup for men who w ere randomized to receive transurethral resection or watchful waiting for moderate symptoms of benign prostatic hyperplasia. Materials and M ethods: A total of 556 patients were evaluated up to 60 months after r andomization providing 966 patient-years of followup for transurethral prostatic resection and 990 for watchful waiting. Patients randomized to watchful waiting were evaluated according to whether they remained on treatment or crossed over to surgery. Outcomes included treatment failure, a genitourinary symptom score, peak flow rate, post-void resi dual urine volume and the degree of bother from genitourinary symptoms . Results: All outcomes were significantly better for transurethral pr ostatic resection than for watchful waiting. Treatment failure rates w ere 10% for transurethral prostatic resection versus 21% for watchful waiting (p = 0.0004). The crossover rate at 5 years was 36% and was po sitively associated with the degree of bother. Men with low pretreatme nt peak flow rates who were randomized to transurethral prostatic rese ction had 85% greater improvement in peak flow rate than comparable me n who were randomized to watchful waiting and eventually crossed over to resection. However, after crossover, bother from genitourinary symp toms was similar to that of the resection group. Conclusions: For men with moderate symptoms of benign prostatic hyperplasia transurethral p rostatic resection has more favorable outcomes up to 5 years of follow up compared to watchful waiting. While many men do well on watchful wa iting, those who undergo transurethral prostatic resection after a tri al of watchful waiting have less improvement in measures of bladder fu nction than men randomized to resection, although there is no differen ce in serious adverse outcomes or bother from genitourinary symptoms.