THE EARLY POSTOPERATIVE MORBIDITY OF TRANSURETHRAL RESECTION OF THE PROSTATE AND OF 4 MINIMALLY INVASIVE TREATMENT ALTERNATIVES

Purpose: We compared the early postoperative morbidity of transurethra l resection of the prostate to minimally invasive treatment alternativ es with respect to the objective rate of complications and subjective morbidity assessed by a patient addressed diary-type questionnaire. Ma terials and Methods: Parameters evaluated preoperatively were the Inte rnational Prostate Symptom Score (I-PSS), free flow study, post-void r esidual, transrectal ultrasonography and a pressure-flow study. The pa tients underwent transurethral resection (28), transrectal high intens ity focused ultrasound (20), visual laser ablation (15), transurethral needle ablation (15) and transurethral electrosurgical vaporization ( 17) of the prostate. On the day of hospital discharge the patients rec eived the questionnaire and were asked to answer daily 7 questions con cerning micturition status. After 6 weeks the questionnaire was return ed and an I-PSS, uroflowmetry and post-void residual were obtained. Re sults: Preoperatively, there was no statistically significant differen ce regarding the I-PSS, peak flow rate, prostate volume and degree of bladder outlet obstruction. After 6 weeks the peak flow rate improved most prominently after transurethral electrosurgical vaporization (+13 .2 ml. per second), transurethral resection of the prostate (+12.3 ml. per second) and visual laser ablation (+11.1 ml. per second). The I-P SS decreased most significantly after transurethral resection (-14.1) and transurethral electrosurgical vaporization (-8.4). There was no di fference regarding the rate of adverse events within the first 6 weeks postoperatively in the 5 treatment arms. Mean duration of catheter dr ainage plus or minus standard deviation was 3.7 +/- 1.2 days after tra nsurethral resection of the prostate, 6.8 +/- 1.7 days after high inte nsity focused ultrasound, 7.8 +/- 1.5 days after visual laser ablation , 2.0 +/- 0.4 days after transurethral needle ablation and 3.3 +/- 0.8 days after transurethral electrosurgical vaporization. Analysis of th e questionnaire revealed that the daytime frequency, degree of hematur ia and incontinence were comparable for all 5 procedures within the fi rst 6 weeks postoperatively. Postoperative dysuria was greatest after visual laser ablation and transurethral electrosurgical vaporization. Regarding the degree of nocturia, there was no improvement after visua l laser ablation, while the remaining 4 procedures yielded a significa nt and comparable decrease. The most significant subjective improvemen t in uroflowmetry was reported after transurethral resection of the pr ostate and transurethral electrosurgical vaporization. Regarding the g lobal quality of life question, the patients were generally more worri ed after visual laser ablation and transurethral needle ablation compa red to the other 3 procedures. Conclusions: The overall morbidity of t ransurethral resection of the prostate within the first 6 weeks postop eratively is equivalent to that of the 4 minimally invasive treatment alternatives evaluated in our study. When comparing the 4 minimally in vasive procedures, no dramatic differences were notable, although visu al laser ablation seems to be associated with a greater degree of morb idity as assessed by this questionnaire.