Controversies in Management: Urologists must grasp the future

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Abstract
Over the past 20 years transurethral resection of the prostate has become the dominant operation in urology. Last year around 40 000 of these operations were done in the United Kingdom, 62% more than in 1975. In the United States the number of operations done under Medicare increased steadily until 1986. Since then, however, the number of operations has fallen by almost a fifth (fig 1). This reduction has occurred despite an increase in the proportion of the population over 65. What could be the explanation for the recent decline of this well tried and tested operation? FIG 1 Probability of recurrent prostatectomy in patients with benign disease according to method of treatment (modified from Wennberg et al1 with permission) Clouds first began to appear on the horizon for transurethral resection of prostate in the mid-1980s when Wennberg et al reported retrospective data suggesting that the 90 day mortality after transurethral resection was nearly 10%, much more than that recorded after open prostatectomy.1 Moreover the same data showed a surprisingly high reoperation rate of 20% over eight years (fig 2). At the same …