RANDOMIZED COMPARISON OF BALLOON DILATION AND TRANSURETHRAL INCISION FOR TREATMENT OF SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA

The concept of relieving the symptoms of benign prostatic hyperplasia (BPH) by dilating the urethra has existed for centuries. Thirty patien ts with a clinically estimated prostate gland size of 25 g or less wer e randomized to either balloon dilation (BDP) or transurethral incisio n of the prostate (TUIP). The mean pretreatment Madsen-Iverson symptom scores in the two groups were 15.0 +/-4.9 (SD) and 15.4 +/- 4.4, resp ectively. The early response rates were 87% for BDP and 86% for TUIP, with the mean symptom scores declining to 3.4 +/- 2.8 after dilation a nd 4.2 +/- 6.6 after incision. Among the 14 patients who initially res ponded to BDP, 2 have been lost to follow-up, 1 died of unrelated caus es at 17 months with no urinary symptoms, 2 remain in response at 32 a nd 38 months, and the other 9 (75 % of those available for evaluation) have developed recurrences. Among the 12 patents who responded to TUI P, 2 have been lost to follow-up, 8 remain in response at 14 to 48 mon ths, and 2 (20%) developed recurrences by 44 months of follow-up. In t he short term, both BDP and TUIP are effective for treating bladder ou tlet obstruction in men with relatively small prostates. However, the effect of dilation appears to be less durable than that of incision.