Systemic Comorbidity Burden Using the ACTIONS Phenotype Predicts Urologic Medication Discontinuation Following Transurethral Resection of the Prostate

Urology. 2019 May;127:91-96. doi: 10.1016/j.urology.2019.02.016. Epub 2019 Feb 26.


Objective: To assess the impact of systemic comorbidities on a validated health phenotype score (ACTIONS: Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea) on outcomes of transurethral resection of prostate (TURP) for benign prostatic hyperplasia (BPH) for symptoms and medication discontinuation.

Materials and methods: Comorbidities of men undergoing TURP for BPH from 2004 to 2015 were assessed with the validated ACTIONS phenotype totaling a score from 0 to 2 for each domain (Anxiety, Cardiovascular, Testosterone, Insulin/diabetes, Obesity, Neurologic, Sleep apnea). BPH medication discontinuation, change in International Prostate Symptom Score, postvoid residual, and patient satisfaction were assessed. Descriptive and comparative statistics were calculated with significance set at P <.05.

Results: The 319 men had a median age of 74.0 (interquartile range 67-78). Mean ACTIONS score was significantly lower in men who discontinued alpha-blockers or 5-alpha reductase inhibitors compared to those who did not (3.37 ± 2.14vs 4.79 ± 2.75, P <.0001). ACTIONS score <4 was significantly associated with medication discontinuation (P = .0014). Lower scores in Testosterone (P = .04), Neurologic (P = .003), and Sleep apnea (P = .04) domains were significantly associated with medication discontinuation. Total ACTIONS score was not independently associated with changes in International Prostate Symptom Score or postvoid residual.

Conclusion: Lower ACTIONS score was associated with BPH medication discontinuation after TURP, suggesting men with lower comorbidity burdens do better after the procedure. The ACTIONS phenotype score is easily calculated and may aid the preoperative counseling of men undergoing TURP for BPH.

MeSH terms

  • Adrenergic alpha-Antagonists / administration & dosage*
  • Aged
  • Cohort Studies
  • Comorbidity
  • Follow-Up Studies
  • Humans
  • Incidence
  • Lower Urinary Tract Symptoms / diagnosis
  • Lower Urinary Tract Symptoms / epidemiology*
  • Lower Urinary Tract Symptoms / surgery
  • Male
  • Middle Aged
  • Phenotype
  • Postoperative Complications / drug therapy
  • Postoperative Complications / physiopathology
  • Predictive Value of Tests
  • Preoperative Care / methods
  • Prostatic Hyperplasia / diagnosis
  • Prostatic Hyperplasia / epidemiology*
  • Prostatic Hyperplasia / surgery*
  • Retrospective Studies
  • Risk Assessment
  • Transurethral Resection of Prostate / adverse effects
  • Transurethral Resection of Prostate / methods*
  • Treatment Outcome
  • Urological Agents / administration & dosage*
  • Urological Agents / adverse effects
  • Withholding Treatment


  • Adrenergic alpha-Antagonists
  • Urological Agents