Korean J Urol.  2008 Jan;49(1):31-36.

Long-Term Results of Transurethral Resection of the Prostate for Large Benign Prostatic Hyperplasia: A Comparative Study with Open Prostatectomy

• Kwak DY
• Chang HS
• Park CH
• Kim CI

Abstract

PURPOSE: We compare the effectiveness and safety of transurethral resection of the prostate(TURP) with those of open prostatectomy for large benign prostatic hyperplasia(BPH), that was over 70cc of prostate volume.
MATERIALS AND METHODS
Seventy-one patients with a prostate volume of more than 70cc and who received TURP were classified to group A, while 41 patients who received open prostatectomy were classified to group B. The International Prostate Symptom Score(IPSS), maximal flow rate(Qmax) and post-voiding residual urine(PVR) volume were evaluated preoperatively and at 1, 3, 5 and over 5 years postoperatively.
RESULTS
The postoperative IPSS, Qmax and PVR were significantly improved after 1 year(p<0.05). The IPSS and Qmax showed no significant differences between the two groups for 1, 3, 5 and over 5 years after operation(p>0.05). The PVR was significantly lower in group B at 1 year post-operation(p<0.05), but there were no significant difference between the groups for 3, 5 and over 5 years after operation(p>0.05). There were 7 cases(9.8%) of re-operation and 3 cases(4.2%) of re-medication after 5 years of operation. There were no major complications for each group.
CONCLUSIONS
On comparison between TURP and open prostatectomy for the patients with large BPH, there were no significant difference in effectiveness and safety for 5 years. Even for the patients with BPH that showed a high volume, TURP is an effective operation that can replace open prostatectomy.

Keyword

Benign prostatic hyperplasia; Transurethral resection of prostate; Prostatectomy

MeSH Terms

Humans
Prostate
Prostatectomy
Prostatic Hyperplasia
Transurethral Resection of Prostate

Figure

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  Fig. 1 Postoperative International Prostate Symptom Score (IPSS) of each group for 1, 3, 5 and over 5 years after operation (p>0.05). TURP: transurethral resection of prostate.

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  Fig. 2 Postoperative maximal flow rate (Qmax) of each group for 1, 3, 5 and over 5 years after operation (p>0.05). TURP: transurethral resection of prostate.

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  Fig. 3 Postoperative post-voiding residual urine (PVR) of each groups for 1 (p<0.05) and 3, 5 and over 5 years after operation (p>0.05). TURP: transurethral resection of prostate.

Reference

1. Mebust WK. Walsh PC, Retik AB, Vaoughan ED, Wein AJ, editors. Transurethral surgery. Campbell's urology. 1998. 7th ed. Phuiladepphia: Saunders;1511–1528.

2. Mearini E, Marzi M, Mearini L, Zucchi A, Porena M. Open prostatectomy in benign prostatic hyperplasia: 10-year experience in Italy. Eur Urol. 1998. 34:480–485.

3. Muzzonigro G, Milanese G, Minardi D, Yehia M, Galosi AB, Dellabella M. Safety and efficacy of transurethral resection of prostate glands up to 150 ml: a prospective comparative study with 1 year of followup. J Urol. 2004. 172:611–615.

4. Waaddeqaard P, Hansen BJ, Christensen SW, Andersen JT, Iversen-Hansen R, Iversen HG. Tranurehral resection of very large prostates. A retrospective study. Int Urol Nephrol. 1991. 23:245–250.

5. Roehrborn CG, McConnell JD, Lieber M, Kaplan S, Geller J, Malek GH, et al. Serum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia. PLESS Study Group. Urology. 1999. 53:473–480.

6. Cho JS, Kim CI, Seong DW, Kim HS, Kim YS, Kim SJ, et al. Cut-off point of large prostate volume for the patients with benign prostatic hyperplasia. Korean J Urol. 2005. 46:1246–1250.

7. Yoon JH. The Korean Prostate Society. Open prostatectomy. Textbook of benign prostatic hyperplasia. 2004. Seoul: Ilchokak;299–321.

8. Park SW, Chung MK. The results of retropubic prostatectomy and transurethral resection of prostate; compare both results, and then investigate the cause of different results. Korean J Urol. 2004. 45:309–314.

9. Oesterling JE. Walsh PC, Retik AB, Vaughan ED, Wein AJ, editors. Retropubic and suprapubic prostatectomy. Campbell's urology. 1998. 7th ed. Philadelphia: Saunders;1529–1541.

10. Lee TH, Hong SJ, Lee MS. Staged transurethral resection of prostate for large benign prostatic hyperplasia: a comparative study with open prostatectomy. Korean J Urol. 2001. 42:1171–1174.

11. Mebust WK, Holtgrewe HL, Cockett AT, Peters PC. Transurethral prostatectomy: immediate and postoperative complication. A cooperative study of 13 participating institutions evaluating 3,885 patients. J Urol. 1989. 141:243–247.

12. Serretta V, Morgia G, Fondacaro L, Curto G, Lo bianco A, Pirritano D, et al. Open prstatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1,800 interventions. Urology. 2002. 60:623–627.

13. Kim HH, Kwak C, Seo SI, Chung H, Lee ES, Lee CW. The effects and complications of transurethral resection for benign prostatic hyperplasia: results of long-term follow-up. Korean J Urol. 1996. 37:268–280.

14. Yoon JH, Chung JI, Choi SH. The effect of a transition zone resection rate of the transurethral resection of prostate (TURP) according to the prostate volume. Korean J Urol. 2005. 46:49–56.

15. Madersbacher S, Lackner J, Brossner C, Rohlich M, Stancik I, Willinger M, et al. Prostate Study Group of the Austrian Society of Urology. Reoperation, myocardial infarction and mortality after transurethral and open prostatectomy: a nation-wide, long-term analysis of 23,123 cases. Eur Urol. 2005. 47:499–504.

16. Roos NP, Wennberg JE, Malenka DJ, Fisher ES, McPherson K, Andersen TF, et al. Mortality and reoperation after open and transurethral resection of the prostate for benign prostatic hyperplasia. N Engl J Med. 1989. 320:1120–1124.

17. Aagaard J, Jonler M, Fuglsig S, Christensen LL, Jorgensen HS, Norgaard JP. Total transurethral resection versus minimal transurethral resection of the prostate--a 10-years follow-up study of urinary symptoms, uroflowmetry and residual volume. Br J Urol. 1994. 74:333–336.

18. Meyhoff HH, Nordling J. Long term results of transurethral and transvesical prostatectomy. A randomized study. Scand J Urol Nephrol. 1986. 20:27–33.

19. Sidney S, Quesenberry CP, Sadler MC, Cattolica EV, Lydick EG, Guess HA. Reoperation and mortality after surgical treatment of benign prostatic hypertrophy in a large prepaid medical care program. Med Care. 1992. 30:117–125.

20. Lu-Yao GL, Barry MJ, Chang CH, Wasson JH, Wennberg JE. Transurethral resection of the prostate among Medicare beneficiaries in the United States: time trends and outcomes. Prostate Patient Outcomes Reserch Team (PORT). Urology. 1994. 44:692–698.