Transurethral Prostatectomy Compared with Incision of the Prostate in the Treatment of Prostatism Caused by Small Benign Prostate Glands

Abstract

In a prospective, randomized study 60 patients with prostatism caused by small prostate glands (estimated weight < 20 g) had either transurethral prostatectomy (TURP, n = 31) or transurethral incision of the prostate (TUI, n = 29). Operating time and blood loss were significantly less in the group that underwent TUI. There were no differences between the groups in number of days with an indwelling catheter or days in hospital after operation. Eight patients in the TUI group required further operation, as did four in the TURP group, one of whom was discharged with a permanent indwelling catheter. In addition one patient developed a urethral stricture. Nine of the failures of treatment occurred within the first month. Fifty-one patients were followed up at 3 months and 47 were also seen at 12 months. Both operations significantly improved symptom scores and maximum flow rates compared with preoperatively, but the improvement in maximum flow rate was significantly better in the TURP group than in the TUI group. At 12 months TURP had also improved micturition time and voided volume, which TUI had not. Neither operation caused any significant change in sexual activity or erective potency postoperatively. Retrograde ejaculation was, however, seen in more than half of the patients in the TURP group, and only one in the TUI group. We recommend TUI for the treatment of prostatism caused by small prostate glands in patients who want to preserve normal ejaculation or are at poor surgical risk.

Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with benign prostatic enlargement

“…Despite marked differences between studies in overall length of stay, in six 135,149,152,157,182,185 they reported it to be shorter for TUIP and in two 180,183 there was no difference. Two RCTs 157,182 reported data that were suitable for synthesis.…”

“…152,157,180,182,183,185 There was marked heterogeneity across the studies, with no clear pattern of results (Figure 15, comparison 05:03:04: 23/263 versus 17/265, RR 1.33, 95% CI 0.77-2.31, p = 0.30). The source of heterogeneity was uncertain, although the lack of separation between urethral stricture and bladder neck contracture may have been a factor as definitions of these conditions varied across the trials.…”

“…Seven studies 135,152,157,180,181,183,185 showed that patients in the TURP group achieved a higher mean or median peak urine flow rate than patients in the TUIP group, and two studies 149,182 showed a higher value in the TUIP group. Only three RCTs 149,157,182 presented data that were sufficiently similar to allow quantitative synthesis (Appendix 9.5, comparison 05:05:01).…”

“…A total of 871 participants were randomised across 11 eligible RCTs and reported in 14 papers. 135,149,152,157,[180][181][182][183][184][185][186][238][239][240] The total number of people allocated to TUIP was 430 and the total allocated to TURP was 441. 135,152,180,181 Of the studies reporting IPSS/AUA scores, 50 participants allocated to TUIP had moderate symptoms of BPE and 20 had severe symptoms compared with 21 with severe and 50 with moderate symptoms among those allocated to TURP.…”

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

“…2 However, TUIP has significantly shorter operative time and hospital stay than TURP. [11][12][13][14] Nevertheless, there is little evidence on long-term effectiveness and there is no clear cutoff prostate size that achieves long-term favourable outcomes after TUIP. 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.…”