Clinical Evaluation of Transurethral Versus Transvesical Prostatectomy

Abstract

The present randomized study gives an evaluation of clinical results 6 months following transurethral (TURP) and transvesical (TVP) prostatectomy in 75 patients with clinical benign medium-sized obstructive prostatic hyperplasia. Following treatment of postoperative urethral stricture, urinary tract infection and residual bladder stones no statistically significant differences could be demonstrated in the effects of TURP and TVP on a calculated total symptom score nor on the individual obstructive and irritative prostatic symptoms. In both groups the obstructive symptoms were best relieved, whereas rather high incidences of irritative symptoms were seen at follow-up. The median duration of incontinence following TURP was 10 weeks compared to 6 weeks following TVP but the difference, however, was insignificant. At follow-up also more patients in the TURP group had urinary incontinence although only one patient in this group with benign histology had daily urinary urge incontinence. Stress incontinence was observed in two patients with malignant histology. Persistent detrusor instability was suggested partly responsible for the follow-up irritative symptoms. In both groups and especially in the TVP group a small decrease in frequency of sexual activity was seen 6 months postoperatively. Seventy per cent of TVP patients and 57% of TURP patients reported retrograde ejaculation at follow-up. More urinary tract infections were seen in the TVP group, however, the differences were insignificant. Twenty-five per cent of TVP patients and 17% of TURP patients developed urethral strictures postoperatively and judged from flowmetry most strictures were obstructive. Momentum flux measurements did not suggest abnormal meatal stiffness in the patients without distal urethral strictures. In both groups high follow-up symptom scores were seen for the patients with large prostates and for patients with high preoperative flow rates. It is concluded that this clinical evaluation did not suggest important differences helpful for the decision whether to perform a TURP or a TVP in a patient with a clinical benign medium-sized prostatic hyperplasia.