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INTRODUCTION
Open transvesical prostatectomy
(OP) and transurethral resection
of the prostate (TURP) are two
old surgical procedures performed
for patients with benign prostatic
hyperplasia (BPH). Currently,
TURP is considered as the
reference or standard treatment for
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Enrollment
Excluded (n = 156):
Not meeting inclusion criteria
(n = 141)
Refused to participate
(n = 15)
Randomized
Allocated to intervention
(n = 52)
Received allocated intervention
(n = 51)
Did not receive allocated intervention
(n = 1): Did not return for surgery
Lost to follow-up (n = 1)
One patient died on the first
postoperative day
Analyzed (n = 50 for
postoperative outcomes; n = 51
for operative outcomes)
Allocation
Allocated to intervention
(n = 51)
Received allocated intervention
(n = 49)
Did not receive allocated intervention
(n = 2): Did not return for surgery
Follow-Up
Lost to follow-up (n = 0)
Analysis
Analyzed (n = 49)
postoperative PFR compared to their preoperative values (postop PFR preop PFR).
Secondary endpoints were IPSS improvement
(preop IPSS postop IPSS), residual urine volume
reduction, re-operation, dysuria, episodes of
cystitis, epididimytis, retrograde ejaculation,
incontinence, and patients quality of life at 8 to
12 months after the operation.(11-14)
The objective of this study was to show at least
2.5 mL/s improvement in PFR in patients who
underwent OP compared with subjects that
underwent TURP. Considering a power of 0.9,
0.05 type I error and 3.7 mL/s standard deviation
for PFR,(14) 46 samples were needed for each
treatment group. To compensate for a presumed
10% loss to follow-up, 102 total samples were
needed.
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RESULTS
The flow chart of patients has been outlined in
Figure. Fifty-one and 49 patients underwent OP
and TURP, respectively. Patients demographic
characteristics before the operation are presented
in Table 1. The only statistically significant
difference in pre-operative variables was for
age with a mean difference of 10 years between
OP and TURP groups. American Society of
Anesthesiology risk score categories 1, 2, and 3
were observed in 4, 31, and 16 patients in the OP
group versus 3, 29, and 17 patients in the TURP
group (P > .05).
Peri-operative and late postoperative data
are presented in Table 2. Early postoperative
complications (during hospitalization) were
observed in 4 patients in OP group (urinary leak
after suprapubic catheter removal in 3 patients
and gastrointestinal bleeding in 1 patient) and
in 3 patients in TURP group (gross hematuria
with clot passage in 2 patients and 1 case of
suprapubic catheter insertion because of urinary
retention after urethral catheter removal and
failure to insert another urethral catheter). No
episodes of transurethral resection syndrome and
no documented thromboembolic events were
observed.
One patient in OP group died the day after the
operation. He was a 73-year-old man, who was
candidate for surgery because of medical therapy
Variable*
Age, years
Body mass index
Prostate size in TRUS, g
IPSS
Peak flow rate, mL/s
Prostate-specific antigen, mg/dL
Urinary incontinence
Surgery indication
Medical therapy failure
Retention
Frequent UTI
Hematuria
Creatinine rise
Residual urine volume, mL
31 (61)
18 (35)
1 (2)
0 (0)
0 (0)
62 (25 to 110)
TURP patients
(N = 49)
61.0 8.0
24.4 3.2
44.4 8.9
27.1 7.7
8.1 (2.8 to 10.4)
2.3 1.0
17 (35)
P
< .001
NS
NS
NS
NS
NS
NS
NS
34 (69)
12 (24)
0 (0)
1 (2)
3 (6)
47 (19 to 93)
NS
OP indicates open transvesical prostatectomy; TURP, transurethral resection of the prostate; TRUS, transrectal ultrasonography; IPSS,
international prostate symptom score; and UTI, urinary tract infection.
*Data are presented as N(%), mean SD, or median (interquartile range).
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OP patients
(N = 50)*
50/1*
7.2 9.2
4 (8)
0 (0)
34.5 11.6
3 (6)
7 (5 to 10)
14 (14 to 30)
0 (0)
0 (0)
3 (6)
2 (4)
4 (8)
17 (34)
14 (28)
22.3 7.4
11.1 (7.6 to 14.2)
60 (25 to 110)
2.3 1.0
TURP patients
(N = 49)
49/0
7.9 10.6
5 (10)
6 (12)
31.0 15.2
5 (10)
5 (3 to 7)
14 (9 to 23)
8 (16)
1 (2)
1 (2)
2 (4)
6 (12)
19 (39)
35 (71)
20.4 8.3
8.0 (2.2 to 12.6)
47 (19 to 90)
2.8 1.4
P
NS
NS
NS
.01
NS
NS
NS
NS
.003
NS
NS
NS
NS
NS
< .001
NS
.02
NS
.04
OP indicates open transvesical prostatectomy; TURP, transurethral resection of the prostate; IPSS, international prostate symptom score; PFR,
peak flow rate; QOL, quality of life; and RUV, residual urine volume.
Data are presented as N (%), mean SD, or median (interquartile range).
*One patient in the OP group died the day after the surgery; therefore, follow-up is available on 50 patients.
Opioid administration to control pain after the operation was necessary in 23 patients (45%) in OP group and 27 patients (55%) in TURP group
(P > .05).
New impotence that was observed after the surgery.
DISCUSSION
Open transvesical prostatectomy is currently
regarded as the only procedure that completely
relieves prostatic obstruction.(2,9,15) It is usually
used for large prostates or when another
pathology necessitating open intervention such
as multiple bladder stones coexists.(16) Previously,
TURP was the most commonly used operation
for obstruction relief and accounted for 60% to
97% of the prostate operations.(4-7,17) The use of
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CONCLUSION
Open transvesical prostatectomy is a safe
operation in 30 to 70 g prostates with few
complications in comparison with TURP. Open
prostatectomy is accompanied by better outcome
in relieving obstruction and less dysuria and
re-operation. The authors believe that OP can
be learned easily and recommend it as a suitable
surgical option to be discussed parallel with
TURP in patients with 30 to 70 g prostates.
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CONFLICT OF INTEREST
None declared.
REFERENCES
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3.
Reich O, Gratzke C, Stief CG. Techniques and longterm results of surgical procedures for BPH. Eur Urol.
2006;49:970-8; discussion 8.
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