Korean J Urol.  2011 Mar;52(3):189-193.

Changes in Surgical Strategy for Patients with Benign Prostatic Hyperplasia: 12-Year Single-Center Experience

• Shin YS
• Park JK

Abstract

PURPOSE
The purpose of this study was to evaluate the annual changes in prostate variables and style of surgical treatment of patients with benign prostatic hyperplasia (BPH) over the past 12 years.
MATERIALS AND METHODS
The subjects were 918 patients (January 1999-November 2010) who were treated by either open prostatectomy or transurethral resection of prostate (TURP). Every year, the performance ratio between open prostatectomy and TURP was evaluated. Before surgery, total and transitional zone volumes of the prostate were measured by transrectal ultrasonography (TRUS). After surgery, resection weight and residual volume of the prostate were measured by TRUS.
RESULTS
From 2001 through 2010, the performance ratio of TURP increased greatly from 89% to 97%. During 1999 to 2010, the total volume of the prostate increased from 40.0 cc to 55.0 cc in the TURP group and from 74.1 cc to 116.7 cc in the open prostatectomy group. During 1999 to 2010, the mean resection volume of the TURP group increased from 2.3 cc to 20.1 cc. Also, the mean resection volume of the open prostatectomy group increased from 59.3 cc to 114.3 cc. During 1999 to 2003, the resection time of the TURP group decreased from 72.9 minutes to 43.2 minutes.
CONCLUSIONS
During 1999 through 2010, the performance ratio between open prostatectomy vs TURP was high for TURP. The total volume and resection volume of the prostate increased annually, and the resection time decreased annually.

Keyword

Prostatectomy; Prostatic hyperplasia; Transurethral resection of prostate

MeSH Terms

Humans
Prostate
Prostatectomy
Prostatic Hyperplasia
Residual Volume
Transurethral Resection of Prostate

Figure

• 

  FIG. 1 The performance ratio of transurethral resection of the prostate and open prostatectomy. TURP: transurethral resection of prostate.

• 

  FIG. 2 The total prostate volume and resection volume in the transurethral resection of the prostate group and open prostatectomy group. TURP: transurethral resection of prostate.

• 

  FIG. 3 The resection volume per minute of TURP. TURP: transurethral resection of prostate.

• 

  FIG. 4 Occurrence of urethral strictures after TURP. TURP: transurethral resection of prostate.

Reference

1. Crowley AR, Horowitz M, Chan E, Macchia RJ. Transurethral resection of the prostate versus open prostatectomy: long-term mortality comparison. J Urol. 1995. 153:695–697.

2. Saigal CS, Movassghi M, Pace J, Joyce G. Economic evaluation of treatment strategies for benign prostatic hyperplasia--is medical therapy more costly in the long run? J Urol. 2007. 177:1463–1467.

3. Reich O, Gratzke C, Bachmann A, Seitz M, Schlenker B, Hermanek P, et al. Morbidity, mortality and early outcome of transurethral resection of the prostate: a prospective multicenter evaluation of 10,654 patients. J Urol. 2008. 180:246–249.

4. Barry MJ, Fowler FJ Jr, Bin L, Pitts JC 3rd, Harris CJ, Mulley AG Jr. The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. J Urol. 1997. 157:10–14.

5. Girman CJ, Epstein RS, Jacobsen SJ, Guess HA, Panser LA, Oesterling JE, et al. Natural history of prostatism: impact of urinary symptoms on quality of life in 2115 randomly selected community men. Urology. 1994. 44:825–831.

6. Habib NA, Luck RJ. Results of transurethral resection of the benign prostate. Br J Surg. 1983. 70:218–219.

7. John MF. Wein AJ, Kavoussi LR, Novick AC, Parrtin AW, Peters CA, editors. Minimally invasive and endoscopic management of benign prostatic hyperplasia. Campbell-Walsh urology. 2007. 9th ed. Philadelphia: Saunders;2803–2844.

8. Misop H, Alan WP. Wein AJ, Kavoussi LR, Novick AC, Parrtin AW, Peters CA, editors. Retropubic and suprapubic open prostatectomy. Campbell-Walsh urology. 2007. 9th ed. Philadelphia: Saunders;2845–2853.

9. 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.

10. de la Rosette JJ, Alivizatos G, Madersbacher S, Perachino M, Thomas D, Desgrandchamps F, et al. EAU Guidelines on benign prostatic hyperplasia (BPH). Eur Urol. 2001. 40:256–263.

11. Roehrborn CG, Bartsch G, Kirby R, Andriole G, Boyle P, de la Rosette J, et al. Guidelines for the diagnosis and treatment of benign prostatic hyperplasia: a comparative, international overview. Urology. 2001. 58:642–650.

12. Chang HS, Choi NG. The results of benign hyperplasia treatment by transurethral resection, open prostatectomy, and TUMT (transurethral microwave thermotherapy). Korean J Urol. 1994. 35:370–375.

13. Kwak DY, Chang HS, Park CH, Kim CI. Long-term results of transurethral resection of the prostate for large benign prostatic hyperplasia: a comparative study with open prostatectomy. Korean J Urol. 2008. 49:31–36.

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

15. Horninger W, Unterlechner H, Strasser H, Bartsch G. Transurethral prostatectomy: mortality and morbidity. Prostate. 1996. 28:195–200.

16. Chacko KN, Donovan JL, Abrams P, Peters TJ, Brookes ST, Thorpe AC, et al. Transurethral prostatic resection or laser therapy for men with acute urinary retention: the ClasP randomized trial. J Urol. 2001. 166:166–170.

17. Park JK, Lee SK, Han SH, Kim SD, Choi KS, Kim MK. Is warm temperature necessary to prevent urethral stricture in combined transurethral resection and vaporization of prostate? Urology. 2009. 74:125–129.

18. Kim J, Moon YE, Hong S, Jeon JP, Chang HW, Kim SJ, et al. Comparison of clinical effect of intrathecally administered fentanyl for elderly patients undergoing urologic surgery. Korean J Anesthesiol. 2008. 55:579–584.

19. Berger AP, Wirtenberger W, Bektic J, Steiner H, Spranger R, Bartsch G, et al. Safer transurethral resection of the prostate: coagulating intermittent cutting reduces hemostatic complications. J Urol. 2004. 171:289–291.

20. Borth CS, Beiko DT, Nickel JC. Impact of medical therapy on transurethral resection of the prostate: a decade of change. Urology. 2001. 57:1082–1085.