FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 332:75-79 January 12, 1995 Number 2 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Transurethral resection of the prostate is the most common surgical treatment for benign prostatic hyperplasia. We conducted a multicenter randomized trial to compare this surgery with watchful waiting in men with moderate symptoms of benign prostatic hyperplasia.

Methods Of 800 men over the age of 54 years who were screened between July 1986 and July 1989, 556 (mean [±SD] age, 66±5 years) were studied (280 in the surgery group and 276 in the watchful-waiting group). Patients' symptoms and the degree to which they were bothered by urinary difficulties were measured with standardized questionnaires and medical evaluations. The primary outcome measure was treatment failure, which was defined as the occurrence of any of the following: death, repeated or intractable urinary retention, a residual urinary volume over 350 ml, the development of bladder calculus, new and persistent incontinence, a high symptom score, or a doubling of the serum creatinine concentration. Patients were followed for three years.

Results Of the men randomly assigned to the surgery group, 249 underwent surgery within two weeks after the assignment. Surgery was not associated with impotence or urinary incontinence. The average follow-up period was 2.8 years. In an intention-to-treat analysis, there were 23 treatment failures in the surgery group, as compared with 47 in the watchful-waiting group (relative risk, 0.48; 95 percent confidence interval, 0.30 to 0.77). Of the men assigned to the watchful-waiting group, 65 (24 percent) underwent surgery within three years after the assignment. Surgery was associated with improvement in symptoms and in scores for urinary difficulties and interference with activities of daily living (P< 0.001 for all comparisons). The outcomes of surgery were best for the men who were most bothered by urinary symptoms at base line.

Conclusions For men with moderate symptoms of benign prostatic hyperplasia, surgery is more effective than watchful waiting in reducing the rate of treatment failure and improving genitourinary symptoms. Watchful waiting is usually a safe alternative for men who are less bothered by urinary difficulty or who wish to delay surgery.

Source Information

From the Department of Veterans Affairs Medical and Regional Office Center, White River Junction, VT 05009, where reprint requests should be addressed to Dr. Wasson.

Full Text of this Article

This article has been cited by other articles:

• Wilt, T. J, N'Dow, J. (2008). Benign prostatic hyperplasia. Part 1--Diagnosis. BMJ 336: 146-149 [Full Text]  
• Connolly, S. S, Fitzpatrick, J. M (2007). Medical treatment of benign prostatic hyperplasia. Postgrad. Med. J. 83: 73-78 [Abstract] [Full Text]  
• Ozden, E., Turgut, A. T., Gogus, C., Kosar, U., Baltaci, S. (2006). Effect of premicturitional bladder volume on the accuracy of postvoid residual urine volume measurement by transabdominal ultrasonography: rate of bladder fullness is of great importance for preventing false-positive residue diagnosis.. J Ultrasound Med 25: 831-834 [Abstract] [Full Text]  
• Shabbir, M., Mumtaz, F. H (2004). Benign prostatic hyperplasia. The Journal of the Royal Society for the Promotion of Health 124: 222-227 [Abstract]  
• He, W., Shih, W. J. (2004). Use of joint models to assess treatment effects on disease markers and clinical events: the ProscarTM Long-Term Efficacy and Safety Study (PLESS). Clin Trials 1: 362-367 [Abstract]  
• Schiff, J. D., Mulhall, J. P. (2004). The Link Between LUTS and ED: Clinical and Basic Science Evidence. J Androl 25: 470-478 [Full Text]  
• Gannon, K., Glover, L., O'Neill, M., Emberton, M. (2004). Men and Chronic Illness: A Qualitative Study of LUTS. J Health Psychol 9: 411-420 [Abstract]  
• McConnell, J. D., Roehrborn, C. G., Bautista, O. M., Andriole, G. L. Jr., Dixon, C. M., Kusek, J. W., Lepor, H., McVary, K. T., Nyberg, L. M. Jr., Clarke, H. S., Crawford, E. D., Diokno, A., Foley, J. P., Foster, H. E., Jacobs, S. C., Kaplan, S. A., Kreder, K. J., Lieber, M. M., Lucia, M. S., Miller, G. J., Menon, M., Milam, D. F., Ramsdell, J. W., Schenkman, N. S., Slawin, K. M., Smith, J. A., the Medical Therapy of Prostatic Symptoms (MTOPS), (2003). The Long-Term Effect of Doxazosin, Finasteride, and Combination Therapy on the Clinical Progression of Benign Prostatic Hyperplasia. NEJM 349: 2387-2398 [Abstract] [Full Text]  
• Vaughan, E. D. Jr. (2003). Medical Management of Benign Prostatic Hyperplasia -- Are Two Drugs Better Than One?. NEJM 349: 2449-2451 [Full Text]  
• Hoffman, R. M (2003). Review: terazosin improves urological symptoms in benign prostatic hyperplasia. Evid. Based Med. 8: 83-83 [Full Text]  
• Brookes, S. T, Donovan, J. L, Peters, T. J, Abrams, P., Neal, D. E (2002). Sexual dysfunction in men after treatment for lower urinary tract symptoms: evidence from randomised controlled trial. BMJ 324: 1059-1059 [Abstract] [Full Text]  
• Barry, M. J, Roehrborn, C. G (2001). Extracts from ""Clinical Evidence"": Benign prostatic hyperplasia. BMJ 323: 1042-1046 [Full Text]  
• Baxby, K, Reynard, J., Jenkins, L., Rose, P., Wilson, T., Farmer, A. (2001). Prostatic symptoms. BMJ 323: 750-750 [Full Text]  
• Lenert, L. A., Cher, D. J. (1999). Use of Meta-analytic Results to Facilitate Shared Decision Making. J. Am. Med. Inform. Assoc. 6: 412-419 [Abstract] [Full Text]  
• Emberton, M., Anson, K. (1999). Fortnightly review: Acute urinary retention in men: an age old problem. BMJ 318: 921-925 [Full Text]  
• McConnell, J. D., Bruskewitz, R., Walsh, P., Andriole, G., Lieber, M., Holtgrewe, H. L., Albertsen, P., Roehrborn, C. G., Nickel, J. C., Wang, D. Z., Taylor, A. M., Waldstreicher, J., The Finasteride Long-Term Efficacy and Safety Stud, (1998). The Effect of Finasteride on the Risk of Acute Urinary Retention and the Need for Surgical Treatment among Men with Benign Prostatic Hyperplasia. NEJM 338: 557-563 [Abstract] [Full Text]  
• Wasson, J. H. (1998). Finasteride to Prevent Morbidity from Benign Prostatic Hyperplasia. NEJM 338: 612-613 [Full Text]  
• Black, N. (1996). Why we need observational studies to evaluate the effectiveness of health care. BMJ 312: 1215-1218 [Full Text]  
• Eisenberg, L., Wasson, J. H., Reda, D. J., Bruskewitz, R. C., Oesterling, J. E. (1995). Treatment of Benign Prostatic Hyperplasia. NEJM 332: 1716-1717 [Full Text]  
• (1995). Surgery vs. Watchful Waiting for BPH. Journal Watch Dermatology 1995: 18-18 [Full Text]  
• (1995). SURGERY VS. WATCHFUL WAITING FOR BPH. JWatch General 1995: 2-2 [Full Text]  
• Oesterling, J. E. (1995). Benign Prostatic Hyperplasia -- Medical and Minimally Invasive Treatment Options. NEJM 332: 99-110 [Full Text]