Doll H A, Black N A, McPherson K
Department of Public Health and Primary Care, University of Oxford, UK.
Br J Urol. 1994 Jun;73(6):669-80. doi: 10.1111/j.1464-410x.1994.tb07554.x.
To investigate which patient and health service factors are predictive of outcome following transurethral resection for benign prostatic hypertrophy.
A total of 388 men were assessed before and 3, 6 and 12 months following surgery. Twenty-one patient characteristics and 12 health service factors were considered. Successful outcome was assessed in terms of avoidance of adverse effects of the operation (survival, lack of early complications and later problems) and improvement in symptoms, health status (assessed in three ways) and quality of life. An overall assessment based on all eight outcome measures was also used. Relationships between possible predictors and outcome were explored whilst controlling for three potential confounders: age, diagnostic category and co-morbidity. A linear logistic model was employed.
Patients who had severe pre-operative symptoms but who otherwise enjoyed good health gained the most benefit from surgery. Generally speaking, outcome was not associated with any of the 12 health service factors studied.
The results support the policy of watchful waiting for mild or moderately symptomatic patients as even if surgery becomes necessary because of a deterioration in the condition, the benefit resulting will be greater. However, any benefits of waiting for surgery would have to be balanced against any increase in urinary tract pathology or co-morbidity that men may suffer whilst waiting, as these will increase the likelihood of an adverse outcome of surgery. The question of whether to wait or not will only finally be resolved by means of a randomized controlled trial comparing transurethral resection of the prostate with watchful waiting.
探讨经尿道前列腺电切术治疗良性前列腺增生后，哪些患者因素和医疗服务因素可预测治疗结果。
对388名男性患者在手术前以及术后3个月、6个月和12个月进行评估。考虑了21项患者特征和12项医疗服务因素。从避免手术不良反应（生存、无早期并发症和后期问题）以及症状改善、健康状况（通过三种方式评估）和生活质量方面评估治疗成功与否。还采用了基于所有八项结果指标的综合评估。在控制年龄、诊断类别和合并症这三个潜在混杂因素的同时，探讨了可能的预测因素与治疗结果之间的关系。采用线性逻辑模型。
术前症状严重但身体健康状况良好的患者从手术中获益最大。一般而言，治疗结果与所研究的12项医疗服务因素中的任何一项均无关联。
结果支持对症状轻微或中度的患者采取观察等待策略，因为即使因病情恶化而需要手术，所获得的益处也会更大。然而，等待手术的任何益处都必须与男性在等待期间可能出现的尿路病理改变或合并症增加相权衡，因为这些会增加手术不良后果的可能性。是否等待的问题最终只能通过一项比较经尿道前列腺电切术与观察等待的随机对照试验来解决。
