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Early surgical management in patients with benign enlargement of prostate with economical constraints

Vinayak G Wagaskar, Ajaykumar R Gajengi, Pranav R Chhajed, Sujata K Patwardhan.


Abstract

Background: Transurethral resection of prostate (TURP) to treat benign enlargement of prostate (BEP) has been the gold standard for decades. It has been demonstrated to be efficient, cost-effective and durable with low long-term complication and retreatment rates.

Objective: To evaluate the results and financial implications of surgical therapy in a subset of BEP patients who underwent TURP with relative indications, after an initial medical therapy.

Materials and Methods: In this open-prospective study, we assessed 100 patients with BEP who were initially on medical therapy but later on opted for TURP based on various reasons. Preoperative financial expenditure on the medications and perioperative expenses were analyzed. The financial implication of an operative procedure against the long-term medical treatment was evaluated. The paired T test was applied wherever possible.

Results: The mean age of the patients was 67.29 (48–84) years; 56% of patients were dependent on their siblings for financial support. Rest 44% possessed monthly average income between Rs. 4,000 and 6,000. There was mean improvement of 17.13 in American Urological Association symptom score, mean increment of 6.68 mL/s in maximum flow rate, and mean decrease of 54.36 mL in postvoid residue post-TURP. Majority (84%) of the patients were happy with TURP when compared with 35% with medical management.

Conclusion: In a public hospital setup with subsidized operative charges, a long-term medical management (>2 years) would prove more expensive compared with an earlier surgical intervention, which would thus be worthwhile in patients with economic constraints.

Key words: BEP, TURP, AUA symptom score, Qmax, PVR






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