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PubMed1991

Transrectal ultrasonography in stage A prostate cancer: detection of residual tumor after transurethral resection of prostate.

To evaluate the ability of transrectal ultrasonography to detect residual cancer in the prostate gland after transurethral resection in patients with stage A cancer, we studied 38 patients with stage A disease (11 stage A1 and 27 stage A2) in whom transrectal ultrasonography was done at least 3 weeks after resection. Each patient underwent radical prostatectomy, and residual cancer was present in 97% of the specimens (peripheral zone cancer in 95% and transition zone cancer in 61%). At sonography we identified hypoechoic areas suggestive of cancer in 10 patients (26%). In the pathological specimen residual cancer was present at the hypoechoic area in 8 of these cases (positive predictive value 80%). In a retrospective review of the sonograms we identified 25 hypoechoic lesions greater than 5 mm. in diameter, including 15 that corresponded to cancer in the radical prostatectomy specimens (positive predictive value 60%). Granulomas due to the transurethral resection were found in 92% of the radical prostatectomy specimens but none appeared hypoechoic on ultrasound. A total of 103 separate cancers was identified in the whole mount step sections of the radical prostatectomy specimens (2.7 cancers per patient). Of the 103 separate cancers 54 were less than 0.1 cc in volume and none of these could be identified in the retrospective review of the sonograms, 37 were 0.1 to 1.0 cc and 5 of these (14%) appeared hypoechoic, and 12 were greater than 1.0 cc and 10 of these (83%) appeared hypoechoic. Hypoechoic lesions greater than 5 mm. in diameter in the transition zone proved to be cancer in 47% of the cases, while 88% of similar lesions in the peripheral zone proved to be cancer. We conclude that suspicious-appearing hypoechoic lesions suggestive of cancer, whether in the peripheral zone or the transition zone, should be biopsied before expectant management of stage A prostate cancer is considered. Transrectal ultrasonography is useful for restaging after transurethral resection and for evaluating the extent of residual cancer in stages A1 and A2 prostate cancer.

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PubMed1986

[Transurethral resection of the prostate in benign prostatic hypertrophy].

Transurethral resection (TUR) is generally accepted as the best treatment for benign prostatic hypertrophy. In spite of the improvement of instruments in recent years, TUR requires skill and experience to be mastered. The irrigating fluid system, operating table and chair, and other equipment in our clinic are reported. These instruments are important to carry out smooth TUR. We use the Stern-McCarthy resectoscope in our clinic, because we prefer a finger-controlled instrument to a spring-cutting instrument. The outline of our technique for TURP and results of 314 clinical cases are reported.

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PubMed1988

Transurethral resection in prostatic cancer.

Complications arising from transurethral and open subcapsular prostatectomy were studied in 121 patients with prostatic cancer and in 121 patients matched in age and prostate weight who had undergone prostatectomy for benign prostatic hypertrophy (BPH). After transurethral resection, cancer patients had a significantly longer hospital stay than did patients with BPH (P less than 0.01) and more had complications, such as perforation and bleeding. Compared to transurethral prostatectomy, open resection resulted in greater blood loss and more complications for the cancer patients. It is concluded that transurethral resection is as safe for most cancer patients as it is for patients with BPH, but the dangers of massive bleeding and dissemination of the cancer cells should not be overlooked.

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PubMed1992

Transurethral resection of prostate immediately after renal transplantation.

The subject of transurethral resection of the prostate (TURP) after renal transplantation has not been evaluated in the urologic literature. We retrospectively compared the outcome of renal transplantation in 8 patients who underwent transurethral resection of the prostate within ten days of renal transplantation with 8 patients who did not undergo prostate surgery. Patients were computer-matched for seven parameters. There was no statistically significant difference in patient survival (6 vs 7) and graft survival (56% vs 88%) between the two groups. However, there was a 25 percent incidence of major perioperative complications (including one mortality) in the TURP group directly attributable to the procedure. Transurethral resection of the prostate can be safely performed immediately after renal transplantation only if urine is sterile, antibiotics and steroids are carefully administered perioperatively, low-gravity irrigation is used, and hemostasis is meticulous.

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PubMed1995

A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate.

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.

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PubMed2002

[Effect of drug therapy on lower urinary tract symptoms indicating the presence of benign prostatic hyperplasia in transurethral resection of the prostate].

OBJECTIVE: Medical therapy of lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) has fundamentally changed. The aim of the study is to verify the suggestion that the medical therapy delayed the need of operative treatment and led to changes in characteristics of patients in need of surgery, or whether it had possibly caused deterioration of the results of surgery. MATERIAL AND METHODS: A group of 137 patients treated by TURP in 1991 (before medical therapy was introduced in Slovakia) was compared with a group of 122 patients treated by TURP in 2001 when medical therapy was offered as the primary initial therapy. We evaluated the patient's age, co-morbidity, type and length of medical therapy of LUTS, indications for operation, the weight of the resected tissue, the length of urinary bladder drainage after the operation and the period of hospitalisation. RESULTS: Patients in 2001 were on average 3.1 years older (p = 0.007), co-morbidity was present in 68.6% patients in 1991 compared to 85.2% in 2001 (not significant), and TURP for objective indications was done in 58.4% of patients in 1991 and in 50% in 2001. In 2001 71 out of 122 (58.2%) patients received medical therapy and 30 of them (24.6%) were operated on for objective indications. The weight of the resected tissue was 20.2 +/- 13.2 grams in 1991 and 24.6 +/- 15.4 grams in 2001 (p = 0.027). In 1991 the catheter was removed 4.5 +/- 1.8 days after the operation compared to 3.1 +/- 2.2 days in 2001 (p = 0.0001). The duration hospitalisation in 1991 was 7.7 +/- 5.7 days compared to 5.2 +/- 3.2 in 2001 (p = 0.0001). CONCLUSIONS: Patients receiving medical therapy have surgery at a higher age. The higher age of patients was not related to co-morbidity or the increased number of operations for objective indications, nor did the complications during surgery increase. On average more of the prostatic tissue was removed and the period of hospitalisation was shorter.

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PubMed1993

Acute pancreatitis following transurethral resection of prostate.

Three cases of acute pancreatitis following transurethral resection of the prostate are reported. The incidence is rare. A review of perioperative data failed to disclose any unique factor except in 1 patient who had an underlying biliary tract disease. Hyperamylasemia or hyperlipaemia in association with abdominal pain and vomiting was noted in all patients to establish the diagnosis. Computed tomography also confirmed the existence of acute pancreatitis. One patient died of respiratory and renal failure. However, early diagnosis and prompt treatment are essential to reduce high mortality. In conclusion, acute pancreatitis should be considered as one of the differential diagnoses in the presence of abdominal pain with vomiting, azotemia or oliguria after transurethral resection of the prostate.

Acute Disease↗

PubMed2002

The risk and effectiveness of transurethral resection of prostate.

BACKGROUND: To advise a patient to have transurethral resection of prostate (TURP) needs information on the benefit and complications of the procedure. Quality assurance also needs present results to be compared with future ones. OBJECTIVES: The authors wanted to know: 1. Whether TURP can decrease theInternational prostate symptom score (IPSS) and improve the Quality of Life (QOL) scores concerning urination at 1.5 months post-operatively for at least 25 per cent of the pre-operative scores?; 2. What are the common medical diseases in this type of patient?; and 3. What are the mortality and immediate complications of TURPF? METHOD: This was a prospective, before-after design trial. All patients who came to have TURP at a tertiary care hospital were studied. IPSS and QOL scores were recorded before surgery and again when the patients came back to follow up at 1.5 months after discharge. Patients were evaluated for cardiopulmonary reserve and congestive heart failure. Anesthetic technique of choice was spinal anesthesia with 0.5 per cent bupivacaine. Anesthetic and surgical complications were recorded if the definitions were met. ANALYSIS: Pre-operative and 1.5 months post-operative scores were compared using paired t-test and 95 per cent confidence interval. RESULTS: During the 13 months there were 269 consecutive males who received TURP. The mean +/- SD age was 70.4 +/- 8.8 years (range 35-97). The mean difference between pre- and post-operative IPSS was 6.7 +/- 9.1 (95% CI 5.2-7.8). Quality of Life also improved, the mean difference between pre- and post-operative QOL was 3.2 +/- 1.6 (95% CI 2.9-3.5). Most patients had ASA class 2. Common pre-operative existing diseases were hypertension (31.6%), ischemic heart disease (18.2%), diabetes (15.6%), and COPD (7.1%). Anesthetic techniques were spinal block (77.3%), epidural block (5.9%), continuous epidural (11.2%), and general anesthesia (5.6%). Intra-operative complications were reported and T URsyndrome occurred in 1 patient (0.37%). There was one surgical death 3 days post-operation, due to septic shock probably from bowel perforation. CONCLUSION: The patients' symptoms and quality of life significantly improved, but there was 1 surgical death and 1 TUR syndrome among 269.

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PubMed2004

Effects of transurethral resection of prostate on the quality of life of patients with benign prostatic hyperplasia.

BACKGROUND: This article investigated the effects of transurethral resection of prostate on quality of life (QOL) and urinary symptoms in patients with benign prostatic hyperplasia (BPH). STUDY DESIGN: In a prospective study, 30 patients without significant comorbidities undergoing transurethral resection of prostate for BPH were studied. Patients completed four validated questionnaires: the International Prostate Symptom Score and the associated QOL index because urinary symptoms, the Montgomery and Asberg Depression Rating Scale, the McGill Pain Questionnaire, and the QOL questionnaire Short Form-36. These were completed preoperatively, on the first postoperative day, on discharge from hospital, and at 1 and 3 months postoperatively. RESULTS: The QOL of patients who undergo transurethral resection of prostate for BPH had significantly improved at 3 months after their operation. The International Prostate Symptom Score scores at 1 month (9.3+/-4.6) and 3 months (5.4+/-5.6) were less than they were preoperatively (19.9+/-7.1). The QOL index because urinary symptoms was less at 1 month (2.4+/-1.9) and at 3 months postoperatively (1.5+/-1.4) in comparison with the preoperative scores (4.5+/-1.2). The Montgomery and Asberg Depression Rating Scale scores at 1 month (5.4+/-6.8) and 3 months (4.9+/-6.5) were less than they were preoperatively (9.2+/-8.3). The McGill Pain Questionnaire sensory and pain rating index scores were less at 3 months than they were preoperatively (p=0.02 and p<0.02 respectively). The McGill Pain Questionnaire affective score was less at 1 month than it was preoperatively (p<0.03). The McGill Pain Questionnaire evaluative scores were less than the preoperative score at all times postoperatively. The role physical (p=0.007), bodily pain (p=0.006), social function (p=0.007), and physical component summary (p=0.007) subsections of the Short Form-36 were greater at 3 months postoperatively when compared with the preoperative scores. CONCLUSIONS: Transurethral resection of prostate is associated with significant improvement in the overall QOL, in addition to urinary symptoms, of patients with BPH at 3 months postoperatively. The magnitude and timing of this improvement may serve as a useful comparator in determining the optimal treatment of patients with BPH.

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PubMed2006

Laparoscopic radical prostatectomy in patients following transurethral resection of the prostate.

OBJECTIVES: Previous transurethral resection of the prostate (TURP) was reported to impose difficulties during open radical prostatectomy. We describe our experience in laparoscopic radical prostatectomy (LRP) following transurethral resection of the prostate. PATIENTS AND METHODS: The series included 35 patients: 22 patients underwent transperitoneal LRP (tpLRP) and 13 underwent extraperitoneal LRP (epLRP). The minimal interval between TURP and laparoscopy was 3 months. Patients' charts were reviewed for their preoperative characteristics, intraoperative difficulties and complications, and outcome. RESULTS: Patients' mean age was 67.5+/-4.4 years. 12 patients were cT1a,b and 23 patients were cT1c/T2. Twenty-two patients underwent tpLRP and 13 underwent epLRP. No statistical difference was found between the preoperative characteristics and the pathological results of cT1a,b vs. T1c/cT2 patients, or tpLRP vs. epLRP patients. Thirty-three procedures were completed laparoscopically and 2 were converted to open surgery. Perioperative complications included two leaking anastomoses, prolonged lymph drainage in 1 case, atelectasis (n=1) and duodenal ulcer (n=1). Twelve positive margins were noted, half of them in pT2 tumors. The mean follow-up was 28.5 months. Twenty-five of 35 patients had more than 12 months of follow-up. Among them 19 patients were completely continent (76%) and 6 (24%), reported mild stress incontinence. CONCLUSIONS: Although LRP following TURP is sometimes more technically difficult, simple modifications in the operative strategy help facilitate surgery. LRP following TURP favorably compares to open radical prostatectomy after TURP and laparoscopy in non-TURP patients.

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PubMed1996

Serum prostate specific antigen levels after transurethral resection of prostate: a longitudinal characterization in men with benign prostatic hyperplasia.

PURPOSE: We studied the long-term effects of adenomectomy on serum levels of prostate specific antigen (PSA) in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A consecutive series of 82 men undergoing adenomectomy for BPH between 1990 and 1992 was studied. PSA levels were determined before and serially after operation for as long as 5 years. RESULTS: Mean PSA decreased from 4.6 ng/ml. preoperatively to 0.7 ng./ml. 6 months postoperatively. These low levels were maintained throughout the 5-year observation period. The PSA decrease correlated with grams of tissue removed (r = 0.54, p < 0.001) and averaged 0.11 ng./ml./gm. Postoperatively mean PSA velocity was 0.01 ng./ml. per year, that is essentially flat, and it was not influenced by patient age, race, type of operation, grams of tissue removed, baseline PSA, PSA density of T1a lesions (7). One to 5 years after adenomectomy 6 of the 82 men had invasive prostatic carcinoma, and PSA levels and velocities remained low. CONCLUSIONS: These data support the concept of transition zone primacy in determining serum PSA. Furthermore, they suggest a possible need for a modified reference range when using PSA to screen for prostatic carcinoma in the estimated 3 million men alive in the United States who previously underwent adenomectomy for BPH.

Adult↗

PubMed1980

Primary cultures of human prostatic epithelial cell from transurethral resection specimens.

The objective of this work was to design a simple and reproducible method of culturing human prostatic epithelial cells from attainable tissue. This type of system is essential for in vitro studies of prostatic cancer and benign prostatic hyperplasia (BPH). The most readily available source of prostatic tissue is the transurethral prostatic resection (TURP). This tissue can be obtained at surgery and processed immediately in the laboratory using standard cell culture techniques. By detailed sectioning and careful histologic examination of the tissue which represented the mirror image of each explant that was cultured, we found that tissue containing viable glandular structure yielded epithelial outgrowths. Pieces of tissue that did not yield epithelial outgrowth were composed only of fibromuscular stroma or contained acini which were damaged (usually cauterized). We concluded that this type of system can be used routinely to study prostatic disease on an individual basis.

Cells, Cultured↗

PubMed1985

[Transurethral punch resection of the prostate (cold punch). Results and complications].

In 1965 the cold punch technique of transurethral prostatic resection was introduced in Germany. The principal differences between the electroresectoscope and the punch resectoscope are explained. This report on the results and complications of cold punch resection of the prostate is based on 3030 patients who were operated upon by this technique. The average age was 71,6 years. 8,2% of the patients were 80 years or older. In 33,6% the operative risk was increased. Intraoperative, early and late complications of the procedure are reported. The mortality of 1,4% over the entire 20 year period was decreased to 0,65% for the last 10 years.

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PubMed2001

Holmium laser resection of the prostate is more cost effective than transurethral resection of the prostate: results of a randomized prospective study.

OBJECTIVES: A cost-effectiveness analysis was carried out comparing electrosurgical transurethral resection of the prostate (TURP) with holmium:yttrium-aluminum-garnet laser resection of the prostate (HoLRP). METHODS: One hundred twenty patients with benign prostatic hyperplasia and urodynamically proved obstruction were randomized to undergo either TURP or HoLRP. Economic and clinical outcome data were recorded prospectively out to 1 year postoperatively. RESULTS: The HoLRP group experienced fewer complications and had a shorter hospital stay and catheterization time than the TURP group, with equivalent clinical outcomes at 12 months. HoLRP cost 24.5% less (New Zealand dollars $651) than TURP during the first year. CONCLUSIONS: Because the clinical outcomes out to 1 year were equivalent, HoLRP was more cost-effective than TURP. On the basis of these savings, a minimum of 93 cases per year are required to recover the capital and service costs of the holmium:yttrium-aluminum-garnet laser.

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PubMed2004

Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients.

PURPOSE: Transurethral electrocautery resection (TURP) is generally regarded as the gold standard surgical treatment for bladder outflow obstruction due to benign prostatic hyperplasia despite its rather high morbidity. The high powered holmium:YAG laser can be used endoscopically to enucleate obstructing prostatic tissue in a relatively bloodless manner. The technique of transurethral holmium laser enucleation of the prostate (HoLEP) was compared to standard TURP for the surgical management of prostate adenomas in a randomized, prospective clinical trial. MATERIALS AND METHODS: A total of 200 urodynamically obstructed patients with a prostate of less than 100 gm on transrectal ultrasound were randomized to HoLEP or TURP. All patients were assessed preoperatively, and 1, 6 and 12 months postoperatively. Patient baseline characteristics, perioperative data and postoperative outcome were compared. All complications were noted. RESULTS: HoLEP was significantly superior to TURP in terms of catheter time, hospital stay and hemoglobin loss but operative time was longer. HoLEP and TURP resulted in a significant improvement in American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes with symptoms scores and residual volume significantly better in the holmium group. Effects on continence and potency were similar in the 2 groups but adverse events were less frequent in the holmium group. CONCLUSIONS: HoLEP and TURP are highly effective procedures for removing obstructing prostatic adenomas. HoLEP resulted in significantly better micturition parameters and less perioperative morbidity.

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PubMed1989

[Transurethral resection of bladder outlet obstruction from carcinoma of the prostate].

Transurethral resection (TUR) in combination with endocrine therapy was performed on 30 patients who were on initial treatment for carcinoma of the prostate and 6 patients who had previously been treated for this disease, 5 of whom were suffering from relapse after a satisfactory response to endocrine therapy. This paper reports the results viewed from potential promoting of metastasis and improvement in bladder outlet obstruction. Prior to TUR, urinary retention was present in 11 of initially treated patients (36.7%) and in three of the previously treated patients (50.0%). The average duration of postoperative indwelling catheter was 3.9 +/- 1.6 days in the initially treated group and 5.2 +/- 3.1 days in the previously treated group. Among the initially treated group, two patients with poorly differentiated adenocarcinoma advancing from Stage C to Stage D (15.4%) developed postoperative metastases which demonstrated at 14 and 42 months; the timing of their occurrence, however, was thought to preclude relating the metastases to TUR. Although metastasis occurred early in two patients among the previously treated group (33.3%), it was considered a natural disease course in relapse cases. Obstructive voiding symptoms recurred postoperatively in three patients of the initially treated group (10.0%) and three patients of the previously treated group (50.0%) during 6 months or more of follow-up periods. UR performed for carcinoma of the prostate proved to be fully safe and effective in the initially treated patients, while admitting that a considerable number of relapses seen in the previously treated patients degraded its benefit to some extent. We conclude that TUR contributed to the better quality of life in both initially and previously treated groups of patients with carcinoma of the prostate.

Adenocarcinoma↗

PubMed2006

[Prostate cancer development after transurethral resection of the prostate--histopathological studies of radical prostatectomy specimens].

PURPOSE: We investigated prostate cancer (ca.) development after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: From 1995 to 2003, 430 patients (pts.) received TURP at Toshiba Rinkan Hospital. Of them, 23 pts. (5.3%) had incidental carcinoma (Stage A), which developed into clinically significant ca. after 1 to 5 years in 5 (22% of Stage A, 1.2% of TURP). In 13 (3.2%) of 407 Non-Stage A pts. (who had no ca. initially), prostate ca. developed after 1 to 7 yrs. A total of 21 pts. (including 3 Stage A pts. diagnosed before 1994) underwent radical prostatectomy. Stage A pts. received regular needle biopsy of prostate (Pbx). Non-Stage A pts. were followed by yearly PSA measurement and digital rectal examination (DRE). Detailed histopathological studies were done on 21 radical prostatectomy specimens. RESULTS: Clinically significant ca. developed in 8 Stage A pts. (all A2) after 1 to 14 yrs. Long term (5 or 10 years) MAB therapy changed moderately-differentiated adenocarcinoma (AC) to poorly-differentiated AC in 2 pts. during follow-up. When ca. developed PSA increased in only 3 of them, DRE was positive just in 1 pt. Tumor invasion was observed mainly in transition zone (TZ), especially anterior to urethra. In spite of no capsular penetration, surgical margin was positive in 2 pts. PSA failure occurred in another 2 pts. Thirteen Non-Stage A pts. showed aggressive ca. (6 moderately-differentiated AC, 6 poorly-differentiated AC, and 1 ductal carcinoma which showed metastasis later), most of which invaded widely in peripheral zone (PZ). Pbx before TURP was done to reveal that there was no cancer in 11 pts. Capsular penetration was seen in 4 pts. Surgical margin was positive in 4 pts. PSA (8.6 +/- 4.0 ng/ml) decreased after TURP but was kept in high level (4.8 +/- 2.2 ng/ml) after 1 year and increased (8.7 +/- 4.5) when cancer was diagnosed in all 13 pts. DRE was positive in 38% of them. Interval between TURP and diagnosis was short in pts. who had cancer of high Gleason Score (GS) or large prostate. CONCLUSIONS: As significant cancer developed in 22% of Stage A pts. (1.2% of TURP) in long term follow-up, regular Pbx (to get TZ tissue) is mandatory regardless of PSA value or DRE. Aggressive cancer developed in 3.2% of Non-Stage A pts. (3.0% of TURP). Pts. with high PSA or abnormal DRE after TURP must receive needle biopsy actively. Considering that more than 4% of TURP pts. eventually require radical prostatectomy, relatively younger pts. who received TURP have to be carefully followed for a long period.

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PubMed1992

Multivariate case-control study of survival following transurethral resection of prostate.

Although prevalence of perioperative mortality following transurethral resection of the prostate (TURP) has steadily declined as reported in several review studies, it has been suggested that with extended follow-up after TURP, mortality exceeds that of an age-matched population. The sample selected for this study was drawn from a data base of 2,005 men who entered a urologic health-screening program. The sample included a group of 25 patients who underwent TURP and a group of 50 age-matched control patients with symptoms of prostatism. Patients were followed for six years, a total of 450 observed person-years. Multivariate analyses based on a general linear model approach for the dependent variable of survival were used to assess gains in predictive efficiency due to combinations of TURP versus control, time, and patient variables. F-ratio hypothesis tests of coefficients of multiple determination for the models indicated that TURP did account for a significant amount of the variability of survival but only after five years of follow-up. However, a far larger proportion of the variance in survival was explained by other patient variables of age, preoperative risk, comorbidity factors, and postoperative urinary disease after all effects due to TURP, follow-up years, and operation cohort years were held constant in the survival prediction equation.

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