Correspondence

Treatment of Benign Prostatic Hyperplasia

N Engl J Med 1995; 332:1716-1717June 22, 1995

Article

To the Editor:

I am disappointed to be faced with a visible contradiction between the two papers on the treatment of benign prostatic hyperplasia in the January 12 issue.1,2

In his review article, Oesterling1 states that the complications of transurethral resection of the prostate include “retrograde ejaculation in 70 to 75 percent of men, impotence in 5 to 10 percent, postoperative urinary tract infection in 5 to 10 percent, and some degree of urinary incontinence in 2 to 4 percent.” In contrast, Wasson et al.,2 summarizing the results of a multicenter randomized trial, state that “surgery was not associated with impotence or urinary incontinence” during an average follow-up period of 2.8 years. Both the men and their spouses or partners described little change in the patients' sexual performance after surgery. The frequency of incontinence and impotence in the treated group was similar to that in the watchful-waiting group.

Oesterling lists the paper by Wasson et al. among his references but says in his text only that it is “the first study in which watchful waiting has been compared with transurethral resection in men with moderate prostatism.” Either he doubts the results or he does not think that one study is sufficient to settle the question. Please, doctors, what should we medical peasants believe?

Leon Eisenberg, M.D.
Harvard Medical School, Boston, MA 02115

2 References

1. 1

   Oesterling JE. Benign prostatic hyperplasia -- medical and minimally invasive treatment options. N Engl J Med 1995;332:99-109
   Full Text | Web of Science | Medline

2. 2

   Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. N Engl J Med 1995;332:75-79
   Full Text | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: The summary of the complications of transurethral resection of the prostate given in the review article reflected the results of the trials — all uncontrolled — that were available through 1993. Although at that time the complications listed were attributed to the surgery, older men in general may have worsening sexual performance and incontinence. Without a control group, surgery would be associated with these problems.

The results of the controlled trial of transurethral resection as compared with watchful waiting conducted by the Veterans Affairs Cooperative Study Group revealed no difference in complications between the two groups, indicating that the problem with the older results was caused by the lack of a control group. More data on the complications are shown in Table 1Table 1Effects of Watchful Waiting and Transurethral Surgery on Incontinence and Sexual Performance in Men with Benign Prostatic Hyperplasia., which includes follow-up results for men with minimal symptoms who were ineligible for randomization, men in the watchful-waiting group, and men in the surgery group, including the 24 percent of men in the watchful-waiting group who had surgery during the study period (usually within the first year). These results, which were not available to the author of the review article, confirm the pattern originally reported: surgery is not a cause of worsened sexual performance and does improve urinary flow.

John H. Wasson, M.D.
Domenic J. Reda, M.S.
Reginald C. Bruskewitz, M.D.
Veterans Affairs Medical and Regional Office Center, White River Junction, VT 05009

Joseph E. Oesterling, M.D.
University of Michigan, Ann Arbor, MI 48109