TRANSURETHRAL RESECTION VERSUS INCISION OF THE PROSTATE - A RANDOMIZED, PROSPECTIVE-STUDY

Objectives, To evaluate longer term effects of transurethral resection (TURF) and incision (TUIP) of the prostate in randomized patients. Me thods, In a randomized, prospective study, 120 patients with symptoms of bladder outlet obstruction caused by smaller benign prostates (esti mated resectable weight less than 20 g) were assigned to TURF or TUIP, Patients were evaluated preoperatively and at intervals postoperative ly as to urinary symptoms (Madsen's questionnaire), sexual function, a nd uroflowmetry. Overall evaluation of outcome of surgery was also ass essed at follow-up visits. Results, Fifty-six patients received a TURF and 61 a TUIP, Three patients refused to participate in the project a fter randomization, and 5 patients were lost to or excluded from follo w-up. A group of 1 12 patients were obtainable for postoperative evalu ation with a mean follow-up time of 34 months (1 to 82 months). Improv ements in mean urinary peak flow rates were seen in both groups throug hout the study period. The peak flow rates generally were higher (but not statistically so) in the TURF group. Postoperative irritative, obs tructive, as well as total symptom scores decreased significantly at a ll followup visits after both TURF and TUIP (P less than or equal to 0 .034). Preoperatively and at all postoperative follow-up there was no statistically significant difference in irritative, obstructive, or to tal symptom scores between TURF and TUIP. The patients indicated an ov erall subjective improvement at all follow-ups in both groups, with no statistically significant difference be tween the treatment groups. F ifteen of 22 (68%) patients receiving TURF and 8 of 23 (35%) in the TU IP group who were sexually active before and after surgery developed p ostoperative retrograde ejaculation (P = 0.020), Postoperatively, 9 (1 6%) of the patients in the TURF and 14 (23%) in the TUIP group receive d further treatment for benign prostatic hyperplasia (BPH)-related inf ravesical obstruction. This difference was not statistically significa nt (P = 0.908). Conclusions. In small prostates TURF and TUIP were gen erally equally effective in relieving bladder outlet obstruction secon dary to BPH. Most surgically treated BPH cases can be well managed by the incision technique, which is an underutilized procedure.