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Factors related to receipt of non-cancer-related transurethral prostatectomy: findings from a large prospective study of 106 769 middle-aged and older Australian men
  1. Grace Joshy1,
  2. Kay Soga1,
  3. Rosemary J Korda1,
  4. Manish I Patel2,3,
  5. Emily Banks1,4
  1. 1National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
  2. 2Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia
  3. 3Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
  4. 4The Sax Institute, Sydney, New South Wales, Australia
  1. Correspondence to Dr Grace Joshy; grace.joshy{at}anu.edu.au

Abstract

Background Transurethral prostatectomy (TURP) is a common surgical intervention for chronic lower urinary tract symptoms (LUTS). Little large-scale evidence exists on factors related to receipt of non-cancer-related TURP.

Methods A prospective study of men aged ≥45 years participating in the 45 and Up Study, a large Australian cohort study, without prior prostatectomy and/or bowel/genital/urinary-tract cancer; questionnaire data were linked to hospitalisations and deaths. HRs for TURP were estimated in relation to multiple factors, adjusting for confounders.

Results There were 3416 incident TURPs among 106 769 men (median follow-up 5.8 years), with rates of 1.8, 5.3, 9.1 and 11.4/1000 person-years for ages 45–54, 55–64, 65–74 and ≥75 years, respectively. Age-adjusted rates of TURP varied markedly according to baseline LUTS from 2.2/1000 person-years with no/mild symptoms to 30.7/1000 person-years with severe symptoms. Annual household income ≥$70 000 versus <$20 000, having private health insurance and living in major cities were associated with higher TURP rates; there were no significant differences according to baseline diabetes, stroke, high blood pressure or cardiovascular disease. Men reporting severe versus no physical functioning limitation, high versus low psychological distress or poor versus excellent self-rated health were 36–51% more likely to undergo procedures overall, but were 24–37% less likely to undergo procedures following additional adjustment for need (baseline LUTS).

Conclusions TURP rates were most strongly related to baseline LUTS and age, consistent with appropriate health services targeting. Lower TURP rates in men experiencing socioeconomic disadvantage and with poor health/disability, after accounting for baseline LUTS, suggest inequity and factors such as frailty and risks related to surgery.

  • men's health
  • transurethral prostatectomy

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Footnotes

  • Contributors EB and GJ conceived the project. GJ wrote the analysis plan. GJ and KS conducted the analysis and drafted the initial version of the manuscript. All authors contributed to a review of the analysis plan, interpretation of results and revisions of the manuscript.

  • Funding This study is funded by the Australian National Health and Medical Research Council (NHMRC project grant number 1024450) and by the NHMRC Centre for Research Excellence in Medicines and Ageing. EB is supported by the NHMRC.

  • Competing interests None declared.

  • Ethics approval NSW Population and Health Services Research Ethics Committee and the Australian National University Human Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Information about data access and governance policies is available at: https://www.saxinstitute.org.au/our-work/45-up-study/for-researchers/

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