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The Clinical Frailty Score as a predictor of Trial of Void outcomes in men undergoing Transurethral Resection of Prostate Surgery

  • Zhuo K 1,
  • Quah S 1,
  • Garcia C 2,
  • Chung A 1
1 Royal North Shore Hospital 2 The Canberra Hospital

Hypothesis / aims of study

With the growing geriatric population, the prevalence of frailty has exponentially increased with a subsequent surge in the number of frail patients undergoing surgeries. One such common operation is the transurethral resection of prostate (TURP) for the treatment of benign prostatic hyperplasia. Whilst there is a link demonstrating frailty and general adverse post-operative outcomes, there is limited research specifically on frailty and trial of void (TOV) outcomes post TURP.
This study aims to investigate possible associations between frailty, TOV outcomes, and post-operative complications following a TURP.

Study design, materials and methods

A retrospective review was conducted on adult patients treated with TURP from two hospitals within Australia, from 01 January 2018 to 31 December 2020. Patient demographic data, pre-operative Clinical Frailty Scores, trial of void outcomes, and complications were recorded and analysed. Clinical frailty scores (CFS) were recorded in accordance to the Dalhousie University Clinical Frailty Scale, ranging from 1 (very fit) to 9 (terminally ill). Complications were categorised according to the Clavien-Dindo (CD) grading system.

Data was analysed using IBM SPSS V27. Descriptive analyses were performed. Normally distributed data was analysed using independent t-tests and ANOVA whilst categorical variables were analysed using Chi-square and Fisher’s exact tests. P-values < 0.05 were considered statistically significant.


226 patients (mean age 78.1 years, range 46-92 years) were identified for this study. Of these patients, 59 were identified as having a CFS of 1-2 (very fit – well, Group A), 140 patients had a CFS of 3-4 (managing well – vulnerable, Group B), and 27 patients had a CFS of 5-7 (mildly, moderately or severely frail, Group C). No patients were identified as having a frailty score of 8-9 (extremely frail – terminally ill). Within the initial TOV, there was a statistically significant difference in failure rates amongst the 3 groups with Group C having the highest failure rate of 33.3% (9/27), followed by Group B with 14.3% (20/140) and then Group A with 13.6 % (8/59) (p=0.04). On analysis of patients who underwent a second TOV after failing the initial TOV, no significant difference in TOV success was found amongst the patient groups (p=0.08).

Overall 49 patients experienced a post-operative complication. The majority of these complications were CD Grade I and II with 22 and 20 patients respectively. There was one mortality in a patient who had a CFS of 7. No significant association was found between frailty groups and rate of complication or severity (p=0.06).

Interpretation of results

In conclusion, greater pre-operative frailty is associated with higher rates of initial TOV failure in post-TURP patients.

Concluding message

Early objective identification of elderly patients with increased frailty is useful to help pre-operative counselling and decision making, manage patient post-operative expectations and optimise patient care.