From gold standard to platinum standard in BPH surgery: a perspective from a tertiary care center of the Indian subcontinent

Abstract

Background: For last eight decades, transurethral resection of the prostate (TURP) has remained the mainstay of surgical treatment for BPH, due to the procedure’s excellent, well-documented and long- lasting treatment efficacy. Patients with clinically bothersome LUTS suggestive of BPH not relieved with medical treatment benefit from transurethral resection/vaporization of prostate using various energy sources. Monopolar TURP has been the main form of treatment for many years in men with BPH and remains the gold standard against which other treatments are evaluated. The aim of this article is to review the role of m-TURP in contemporary BPH management.Methods: This retrospective study included 275 patients with bothersome LUTS and histologically confirmed BPH, who underwent m-TURP at Deprtment of Urology and Renal Transplantation between July 2010 and July 2015 and were in follow up for at least 24 months in the Urology OPD. The most frequent indication (50-60%) for TURP is LUTS refractory to medical therapy.Results: A total of 274 patients were divided into 3 groups based on prostate volume of less than 40 gram (Group A), 40 to 80 grams (Group B) and more than 80gm (Group C). Statistically, deranged EFG was significantly associated and correlated with Group B). The mean preoperative hemoglobin level for the entire patient population was 13.14±1.26 whereas the post-operative hemoglobin level was 12.22±1.39gm/dl. Similarly, the mean preoperative sodium level for the entire patient population was 137±4.26 whereas the post-operative level was 130±5.04mEq/L.Conclusions: M-TURP is adequate for its intended use as an effective learning tool and as a substantial practical tool for managing BPH; m-TURP results depend on surgeons’ experience, the patient’s prostate volume- and comorbidities.