Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Clinical
  • Published:

The impact of surgical duration on complications after transurethral resection of the prostate: an analysis of NSQIP data

Prostate Cancer and Prostatic Diseases volume 22, pages 303–308 (2019)Cite this article

Subjects

Abstract

Background

Transurethral resection of the prostate is the most commonly performed procedure for the management of benign prostatic obstruction. However, little is known about the effect surgical duration has on complications. We assess the relationship between operative time and TURP complications using a modern national surgical registry.

Methods

We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) from 2006 to 2016 for patients undergoing TURP. Patients were separated into five groups based on operative time: 0–30 min, 30.1–60 min, 60.1–90 min, 90.1–120 min, and greater than 120 min. Standard statistical analysis, including multivariate regression, was performed to determine factors associated with complications.

Results

31,813 patients who underwent TURP were included. The overall complication rate was 9.0% and increased significantly with longer surgical duration (p < 0.001). Longer operative time was associated with a greater risk of postoperative sepsis or shock, transfusion, reoperation, and deep vein thrombus or pulmonary embolism. Longer surgical duration was associated with increased odds of any complication and, specifically, blood transfusion after controlling for age, race, comorbidities, American Society of Anesthesia (ASA) class, type of anesthesia administered, and trainee involvement. The adjusted risk of each of the above complications remained significantly increased for surgeries lasting longer than 120 min.

Conclusions

As surgical duration increases, there is a significant increase in the rate of complications after TURP. These data demonstrate that this procedure is safest when performed in under 90 min.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Oelke M, Bachmann A, Descazeaud A, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64:118–40. https://doi.org/10.1016/j.eururo.2013.03.004.

    Article  PubMed  Google Scholar 

  2. Malaeb BS, Yu X, McBean AM, Elliott SP. National trends in surgical therapy for benign prostatic hyperplasia in the United States (2000-2008). Urology. 2012;79:1111–6. https://doi.org/10.1016/j.urology.2011.11.084.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chughtai BI, Simma-Chiang V, Lee R, et al. Trends and utilization of laser prostatectomy in ambulatory surgical procedures for the treatment of benign prostatic hyperplasia in New York state (2000-2011). J Endourol. 2015;29:700–6. https://doi.org/10.1089/end.2014.0692.

    Article  PubMed  Google Scholar 

  4. Bhojani N, Gandaglia G, Sood A, et al. Morbidity and mortality after benign prostatic hyperplasia surgery: data from the American College of Surgeons national surgical quality improvement program. J Endourol. 2014;28:831–40. https://doi.org/10.1089/end.2013.0805.

    Article  PubMed  Google Scholar 

  5. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol. 1989;141:243–7.

    Article  CAS  Google Scholar 

  6. Doll HA, Black NA, McPherson K, Flood AB, Williams GB, Smith JC. Mortality, morbidity and complications following transurethral resection of the prostate for benign prostatic hypertrophy. J Urol. 1992;147:1566–73.

    Article  CAS  Google Scholar 

  7. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP)--incidence, management, and prevention. Eur Urol. 2006;50:969–79. https://doi.org/10.1016/j.eururo.2005.12.042. discussion980.

    Article  PubMed  Google Scholar 

  8. Reich O, Gratzke C, Bachmann A, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008;180:246–9. https://doi.org/10.1016/j.juro.2008.03.058.

    Article  PubMed  Google Scholar 

  9. Stucki P, Marini L, Mattei A, Xafis K, Boldini M, Danuser H. Bipolar versus monopolar transurethral resection of the prostate: a prospective randomized trial focusing on bleeding complications. J Urol. 2015;193:1371–5. https://doi.org/10.1016/j.juro.2014.08.137.

    Article  CAS  PubMed  Google Scholar 

  10. Mayer EK, Kroeze SGC, Chopra S, Bottle A, Patel A. Examining the “gold standard”: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int. 2012;110:1595–601. https://doi.org/10.1111/j.1464-410X.2012.11119.x.

    Article  PubMed  Google Scholar 

  11. Skolarikos A, Rassweiler J, de la Rosette JJ, et al. Safety and efficacy of bipolar versus monopolar transurethral resection of the prostate in patients with large prostates or severe lower urinary tract symptoms: post hoc analysis of a european multicenter randomized controlled trial. J Urol. 2016;195:677–84. https://doi.org/10.1016/j.juro.2015.08.083.

    Article  CAS  PubMed  Google Scholar 

  12. Bach T, Wölbling F, Gross AJ, et al. Prospective assessment of perioperative course in 2648 patients after surgical treatment of benign prostatic obstruction. World J Urol. 2017;35:285–92. https://doi.org/10.1007/s00345-016-1866-7.

    Article  PubMed  Google Scholar 

  13. Mamoulakis C, Ubbink DT, de la Rosette JJMCH. Bipolar versus monopolar transurethral resection of the prostate: a systematic review and meta-analysis of randomized controlled trials. Eur Urol. 2009;56:798–809. https://doi.org/10.1016/j.eururo.2009.06.037.

    Article  PubMed  Google Scholar 

  14. Tang Y, Li J, Pu C, et al. Bipolar transurethral resection versus monopolar transurethral resection for benign prostatic hypertrophy: a systematic review and meta-analysis. J Endourol. 2014;28:1107–14. https://doi.org/10.1089/end.2014.0188.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cornu J-N, Ahyai S, Bachmann A, et al. A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: an update. Eur Urol. 2015;67:1066–96. https://doi.org/10.1016/j.eururo.2014.06.017.

    Article  PubMed  Google Scholar 

  16. Shiloach M, Frencher SK, Steeger JE, et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg. 2010;210:6–16. https://doi.org/10.1016/j.jamcollsurg.2009.09.031.

    Article  PubMed  Google Scholar 

  17. Haridas M, Malangoni MA. Predictive factors for surgical site infection in general surgery. Surgery. 2008;144:496–501. https://doi.org/10.1016/j.surg.2008.06.001. discussion501-503.

    Article  PubMed  Google Scholar 

  18. Hollenbeck BK, Miller DC, Taub D, et al. Risk factors for adverse outcomes after transurethral resection of bladder tumors. Cancer . 2006;106:1527–35. https://doi.org/10.1002/cncr.21765.

    Article  PubMed  Google Scholar 

  19. Matulewicz RS, Sharma V, McGuire BB, Oberlin DT, Perry KT, Nadler RB. The effect of surgical duration of transurethral resection of bladder tumors on postoperative complications: an analysis of ACS NSQIP data. Urol Oncol. 2015;33:338.e19–24. https://doi.org/10.1016/j.urolonc.2015.05.011.

    Article  Google Scholar 

  20. Procter LD, Davenport DL, Bernard AC, Zwischenberger JB. General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg. 2010;210:60–65.e1-2. https://doi.org/10.1016/j.jamcollsurg.2009.09.034.

    Article  PubMed  Google Scholar 

  21. Uchida T, Ohori M, Soh S, et al. Factors influencing morbidity in patients undergoing transurethral resection of the prostate. Urology. 1999;53:98–105.

    Article  CAS  Google Scholar 

  22. Gilling PJ, Mackey M, Cresswell M, Kennett K, Kabalin JN, Fraundorfer MR. Holmium laser versus transurethral resection of the prostate: a randomized prospective trial with 1-year followup. J Urol. 1999;162:1640–4.

    Article  CAS  Google Scholar 

  23. Kuntz RM, Ahyai S, Lehrich K, Fayad A. Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients. J Urol. 2004;172:1012–6. https://doi.org/10.1097/01.ju.0000136218.11998.9e.

    Article  PubMed  Google Scholar 

  24. Vivien A, Lazard T, Rauss A, Laisné MJ, Bonnet F. Infection after transurethral resection of the prostate: variation among centers and correlation with a long-lasting surgical procedure. Association pour la Recherche en Anesthésie-Réanimation. Eur Urol. 1998;33:365–9.

    Article  CAS  Google Scholar 

  25. Fan S, Gong B, Hao Z, et al. Risk factors of infectious complications following flexible ureteroscope with a holmium laser: a retrospective study. Int J Clin Exp Med. 2015;8:11252–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Lojanapiwat B, Kitirattrakarn P. Role of preoperative and intraoperative factors in mediating infection complication following percutaneous nephrolithotomy. Urol Int. 2011;86:448–52. https://doi.org/10.1159/000324106.

    Article  CAS  PubMed  Google Scholar 

  27. Colau A, Lucet JC, Rufat P, Botto H, Benoit G, Jardin A. Incidence and risk factors of bacteriuria after transurethral resection of the prostate. Eur Urol. 2001;39:272–6. 52452.

    Article  CAS  Google Scholar 

  28. Wagenlehner FME, Wagenlehner C, Schinzel S, Naber KG, Working Group. “Urological Infections” of German Society of Urology. Prospective, randomized, multicentric, open, comparative study on the efficacy of a prophylactic single dose of 500 mg levofloxacin versus 1920 mg trimethoprim/sulfamethoxazole versus a control group in patients undergoing TUR of the prostate. Eur Urol. 2005;47:549–56. https://doi.org/10.1016/j.eururo.2005.01.004.

    Article  CAS  PubMed  Google Scholar 

  29. JTH SchaepkensVanRiempst, RHGG VanHee, JJJ Weyler. Deep venous thrombosis after laparoscopic cholecystectomy and prevention with nadroparin. Surg Endosc. 2002;16:184–7. https://doi.org/10.1007/s004640090048.

    Article  Google Scholar 

  30. Clarke-Pearson DL, Dodge RK, Synan I, McClelland RC, Maxwell GL. Venous thromboembolism prophylaxis: patients at high risk to fail intermittent pneumatic compression. Obstet Gynecol. 2003;101:157–63.

    PubMed  Google Scholar 

  31. Olcese SP, Derosa R, Kern SQ, Lustik MB, Sterbis JR, McMann LP. Comparison of outcomes after TURP versus photoselective vaporization of the prostate with respect to trainee involvement utilizing ACS NSQIP. Prostate Cancer Prostatic Dis. 2014;17:227–32. https://doi.org/10.1038/pcan.2014.13.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Urology, Department of Surgery, University of Chicago Medicine, Chicago, IL, USA

    Christopher B. Riedinger, Richard J. Fantus, Ryan P. Werntz, Joseph F. Rodriguez & Norm D. Smith

  2. Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Richard S. Matulewicz

Authors
  1. Christopher B. Riedinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard J. Fantus
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard S. Matulewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryan P. Werntz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joseph F. Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Norm D. Smith
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher B. Riedinger.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Riedinger, C.B., Fantus, R.J., Matulewicz, R.S. et al. The impact of surgical duration on complications after transurethral resection of the prostate: an analysis of NSQIP data. Prostate Cancer Prostatic Dis 22, 303–308 (2019). https://doi.org/10.1038/s41391-018-0104-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41391-018-0104-3

This article is cited by

Search

Advanced search

Quick links