Hrishi Joshi1, Gaurav Sali2, Louise Paramore3, Richard Jones4, Henry Lazarowicz5, Magda Lucia Kujawa6, Amol Pandit7, Rotimi David8, Katherine Wilson9, Christopher Bates10, I Shergill11, Christine Gan12, Tamer El-Husseiny12, Bashir Mukhtar13, Timson Appanna14, Rajan Veeratterapillay15, Christopher Harding15, Matthew Crockett16, Christopher Dawson17, Richard Simpson18, Bachar Zelhof19, B Starmer20, Rono Mukherjee20, Andreas Bourdoumis21, Joseph Jelski22, H Hashim22, John McCabe23, Greg Shaw24, Karyee Chow25, Christopher Betts26. 1. Consultant Urological Surgeon and Honorary lecturer, Department of Urology, University Hospital of Wales, UK. 2. Clinical Fellow in Urology, Department of Urology, University Hospital of Wales, UK. 3. Specialist Registrar in Urology, Department of Urology, University Hospital of Wales, UK. 4. Specialist Registrar in Urology, Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK. 5. Consultant Urological Surgeon, Department of Urology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, UK. 6. Consultant Urological Surgeon, Department of Urology, Stepping Hill Hospital, UK. 7. Consultant Urological Surgeon, Department of Urology, Morriston Hospital, UK. 8. Clinical Fellow in Urology , Department of Urology, Morriston Hospital, UK. 9. Specialist Registrar in Urology, Department of Urology, Royal Gwent Hospital, UK. 10. Consultant Urological Surgeon, Department of Urology, Royal Gwent Hospital, UK. 11. Consultant Urological Surgeon, Department of Urology, Wrexham Maelor Hospital, UK. 12. Consultant Urological Surgeon, Department of Urology, Charing Cross Hospital - Imperial College Healthcare NHS Trust, UK. 13. Specialist Registrar in Urology, Department of Urology, Cwm Taf Morgannwg Health Board Royal Glamorgan Hospital, UK. 14. Consultant Urological Surgeon, Department of Urology, Cwm Taf Morgannwg Health Board Royal Glamorgan Hospital, UK. 15. Consultant Urological Surgeon, Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, UK. 16. Specialist Registrar in Urology, Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, UK. 17. Consultant Urological Surgeon, Department of Urology, University Hospitals Birmingham NHS Foundation Trust, UK. 18. Specialist Registrar in Urology, Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK. 19. Consultant Urological Surgeon, Department of Urology, Lancashire Teaching Hospitals NHS Foundation Trust, UK. 20. Consultant Urological Surgeon, Department of Urology, Leighton Hospital, Mid Cheshire Hospitals NHS Foundation Trust, UK. 21. Consultant Urological Surgeon, Department of Urology, Penine Acute Hospitals NHS Trust, The Royal Oldham Hospital, UK. 22. Specialist Registrar, Department of Urology, Southmead Hospital, North Bristol NHS Trust, UK. 23. Consultant Urological Surgeon, Department of Urology, St Helens and Knowsley Teaching Hospitals NHS Trust, UK. 24. Consultant Urological Surgeon, Department of Urology, University College London Hospitals NHS Foundation Trust, UK. 25. Consultant Urological Surgeon, Department of Urology, Wythenshawe Hospital, Manchester University NHS Foundation Trust, UK. 26. Consultant Urological Surgeon, Department of Urology, Salford Royal NHS Foundation Trust, UK.
Abstract
OBJECTIVE: In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. MATERIALS AND METHOD: A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. RESULTS: 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. CONCLUSION: Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.
OBJECTIVE: In view of changing landscape of surgical treatment for LUTS secondary to BPE, this audit was undertaken to assess key aspects of the processes and outcomes of the current interventional treatments for BPE, across different units in the UK. MATERIALS AND METHOD: A multi-institutional snapshot audit was conducted for patients undergoing interventions for LUTS/BPE over 8-week period. Using Delphi process two-part proforma was designed to capture data. RESULTS: 529 patients were included across 20 NHS trusts in England and Wales. Median age was 73 years. Indications for surgery were acute retention (47%) and LUTS (45%). 80% of patients had prior medical therapy. TURP formed the commonest procedure. 27% patients had <23 hour hospital stay. Immediate (21%) and delayed (18%) complications were Clavien-Dindo <2 category. High proportion of patients reported residual symptoms. Type and indication of surgery were significant predictor of complications, length of stay and failure of TWOC outcomes, on multivariate analyses. There were variations in departmental processes, 50% centres used PROMs. CONCLUSION: Monopolar TURP still remains the commonest intervention for BPE. Most departments are adopting newer technologies. The audit identified opportunities for development of consistent, effective and patient centric practices as well as need for large-scale focused studies.