Mortality and morbidity of prostatectomy. How far does preselection and pre-operative care influence the result?

Mortality and morbidity rates of prostatectomy have been progressively reduced over the past years, but with increasing ageing of the population, a limit is reached when medical complicating factors ensue, beyond which operative intervention carries an unacceptable risk. Results of surgery have little meaning if patients who are not fit or too old are excluded and not shown. It is with the above objectives in view that a prospective study is reported where all patients who presented or were admitted with prostatic symptoms over 1 year were recorded. There were 246 patients. Age, presentation and ASA (American Society of Anesthesiologists) status, post-operative problems and stay were noted. Joint assessment with a senior anaesthetist was performed in all higher-risk patients. 132 patients were operated on, 91% by transurethral resection of the prostate. 66% were ASA 2 and 3. Age itself bore no relation to length of post-operative stay but ASA status did. There was no mortality. However, 12 (9%) ASA 4 cases were excluded from surgery. It is concluded that with careful assessment, patients who are old and medically compromised can undergo prostatectomy safely, but one has to identify accurately those unsuitable for surgery and offer alternative treatment.