Peer-review started: September 25, 2018
First decision: November 20, 2018
Revised: November 22, 2018
Accepted: January 21, 2019
Article in press: January 22, 2019
Published online: March 12, 2019
Processing time: 169 Days and 10.1 Hours
Trans-urethral resection of prostate (TURP) is one of the most commonly performed operations in urology to treat bladder outflow obstruction (BOO) in men. TURP surgery is also a key for endo-urological training in the British National Health Service (NHS) for training junior urologists. The working hypothesis is that prostate resection speed (PRS) in the context of bipolar TURP surgery, is not a key factor in major complication rates or broad patient outcomes at 3 mo after surgery, and therefore supervising consultants should not focus primarily on resection speed when teaching TURP.
To investigate objective differences in consultants vs trainees PRS and whether PRS affected complication rates/outcomes after TURP.
Retrospective descriptive study analyzing patient case-notes, operative and electronic records, study undertaken at Burton Queen’s Hospital NHS Foundation Trust, United Kingdom, a secondary care centre in the public sector of the NHS. Participants included: all Bipolar TURPs undertaken between 13/04/2016 and 27/06/2017. Exclusions: patients undergoing concomitant operations or where intra-operative equipment problems occurred. Resected prostate (g), operative time, post-operative complications and outcomes at 3-mo were obtained from electronic records. Clavien-Dindo Grade II complications or above considered significant. Binary successful yes/no outcome at 3-mo after surgery included both patients who reported moderate to significant symptom improvement, or being catheter-free for those catheterized before TURP.
157 patients were identified. After exclusion a total of 125 patients were included from analysis. The mean PRS for trainees (0.34 g/min) was found to be lower than the mean PRS for consultants (0.41 g/min). The operating urologist’s PRS was not observed to be related to the number of TURPs that they performed during the period of the study. The trainee vs consultant means post-operative success rates (86.5% vs 90.5%) were comparable. The Trainees’ patients did not suffer any significant complications as defined by the study. There was no clear relationship observed between PRS and the rate of significant post-operative complications or patients’ 3-mo binary successful outcome. PRS was noted to increase with increasing intra-operative experience for both Trainees 1 and 2 when comparing the first half of their TURPs to their latter half.
Consultants have a higher PRS in comparison to trainees. There is no trend between PRS and significant post-operative complication rates or 3-mo outcomes.
Core tip: Transurethral resection of prostate (TURP) is a common operation for treating bladder outflow obstruction. Prolonged intra-operative resection time is reported to increase complication rates. This study aimed to assess for objective differences in consultants vs trainees prostate resection speed (PRS) and whether differences in PRS affected complication rates and broad patient outcomes after TURP. The study found higher PRS for consultants however no difference in serious complications or broad patient outcomes. The authors therefore recommend that consultant urologists should not primarily focus on their trainee’s PRS when training them in TURP surgery.