Selective Transurethral Resection of the Prostate Combined with Transurethral Incision of the Bladder Neck for Bladder Outlet Obstruction in Patients with Small Volume Benign Prostate Hyperplasia (BPH): A Prospective Randomized Study

Abstract

PurposeTransurethral resection of the prostate (TURP) has a high failure rate in patients with small volume benign prostate hyperplasia (BPH) with bladder outlet obstruction (BOO). We describe and report the results of an alternative surgical method, selective transurethral resection of the prostate (STURP) in combination with transurethral incision of the bladder neck (TUIBN).MethodsPatients were randomized to receive TURP or STRUP+TUIBN in combination with TUIBN. Maximum urinary flow rate (Qmax), voided volume, and post voiding residual volume (PVR) were assessed at baseline and at 1, 3, and 6 months after surgery. Efficacy of treatment was assessed by lower urinary tract symptoms and IPSS.ResultsSixty three patients received STRUP+TUIBN and 61 received TURP. Surgical time, amount of prostate tissue resected, and blood loss was the same in both groups (all, p>0.05). The mean duration of follow-up was 9.02 and 8.53 months in patients receiving TURP and STRUP+TUIBN, respectively. At 6 months postoperatively, IPSS was 4.26±1.22 and 4.18±1.47 in patients receiving TURP and STRUP+TUIBN, respectively (p>0.05), and the Qmax in patients receiving STRUP+TUIBN was markedly higher than in those receiving TURP (28.28±6.46 mL/s vs. 21.59±7.14 mL/s; p<0.05). Bladder neck contracture and urinary tract infections were observed in 3 and 5 patients receiving TURP, respectively, and none in STURP.ConclusionsSTRUP+TUIBN may offer a more effective and safer alternative to TURP for small volume BPH patients.

Comparative Analysis of Prostate Volume as a Predictor of Outcome in Prostate Artery Embolization

“…In large gland sizes, specifically 4 80 cm 3 , longer operative times are required, with increased bleeding and anesthesia-related complications. Transurethral resection of the prostate has also been reported to have failure rates as high as 20% in small-volume prostates (o 50 cm 3 ), necessitating future surgical revision in more than 5% of patients (2,3). Laser vaporization in small-volume BPH has been associated with a 7% incidence of bladder neck contractures (4,5).…”

A comparison of incidences of bladder neck contracture of 80- versus 180-W GreenLight laser photoselective vaporization of benign prostatic hyperplasia

“…The reasons for development of BNC after PVP remain unknown. The principle of PVP by GreenLight laser is based on the thermal interaction between laser and biological tissue, which may inadvertently cause postoperative BNC due to the thermal damage on bladder neck tissue by intraoperative hemostasis and the resection of bladder neck tissue [22]. A prophylactic bladder neck incision at the end of the procedure will lower bladder neck tension and avoid the possibility of incisional adhesions from excessive residual gland tissue, thereby reducing the incidence of BNC [22,23].…”

“…The principle of PVP by GreenLight laser is based on the thermal interaction between laser and biological tissue, which may inadvertently cause postoperative BNC due to the thermal damage on bladder neck tissue by intraoperative hemostasis and the resection of bladder neck tissue [22]. A prophylactic bladder neck incision at the end of the procedure will lower bladder neck tension and avoid the possibility of incisional adhesions from excessive residual gland tissue, thereby reducing the incidence of BNC [22,23]. Several factors are associated with the efficiency of laser treatment and its thermal damage to the adjacent normal tissues degree, including the power density, the wavelength, the irradiation time, the exit angle of fiber, and the beam profile of the laser and defines the extent between vaporization and coagulation [16,17].…”

Holmium laser transurethral incision of the prostate: Can prostate size predict the long-term outcome?

“…Prostate size was found to correlate with BOO Prostate size and long-term outcome in patients with a prostate volume ≥30 g, a finding which was not seen in patients with smaller prostates. 4 Therefore, other contributing BOO pathophysiological factors could play a role, whereas prostate size seems to correlate with TUIP outcomes. Consequently, it would seem logical not only to evaluate the outcome of TUIP using the new era of laser management for infravesical obstruction, but also to determine the predictors of success for this minimally invasive simple procedure.…”

“…3 To avoid this high failure rate, Li and colleagues recommended selective TURP in combination with transurethral incision of the bladder neck in patients with small obstructing prostate. 4 However, in the era of laser prostatectomy, holmium laser energy is an excellent alternative to incise the prostate due its satisfactory cutting effect and superior visibility than electrocautery. Moreover, it has a minimal tissue penetration depth of 0.4 mm, with less probability of scarring.…”