INTRODUCTION

Surgical treatment for LUTS/BPH has experienced rapid changes with new treatments becoming available, however there is limited data on current national practices.

Method
A national audit was conducted for patients undergoing surgery for LUTS/BPE over an eight week period. A two part proforma, capturing departmental data examining processes (8 items) and patient outcome data (25 items), was designed and reviewed (NIHR Urology and BAUS Endourology committee). The proforma was completed at all sites and data analysis performed centrally.

RESULTS

503 patients underwent a procedure for LUTS/BPE across 19 NHS trusts in England and Wales from March-April 2018. Mean age of the cohort was 72 years (range 30-94). The most common indication for surgery was acute retention (46%) or LUTS (46%) (other 8%) with mean tissue resection of 24 grams. 54 patients had prior surgical treatment. TURP (monopolar 47%, bipolar 24%) was the commonest procedure. Immediate 14.5% (12.9% Clavien-Dindo≤2) and delayed 9.9% (9.1%≤2) complications were reported including four blood transfusions. Type of surgery performed (ablative vs non-ablative) was a significant predictor of immediate complications, length of stay and outcomes on multivariate analyses. NICE-approved treatments were offered often (59%) or always (18%). 65% of centres had consultant-led follow-up with 24% of centres reporting that the needs of trainees had an impact on treatment.

CONCLUSION

There appear to be significant variations in patient selection, pathways and treatments offered that may impact overall outcomes and resources. Newer treatments might warrant further detailed evaluation. This audit provides a framework for further focused research.