Transurethral Resection of Prostate—Lessons Learnt

Abstract

Introduction & Objective: Transurethral resection of prostate (TURP) is the gold standard of treatment for patients with benign prostatic enlargement (BPE). But, TURP is criticised due to its morbidity and mortality. We analysed our two decade data and found that the morbidity can be reduced by taking simple precautions in the later decade. Materials and Methods: A total of 13786 patients were studied in the past two decades ( Jan. 1994-Dec. 2014)operated by single surgeon, grouped in A ( Jan. 1994-Dec. 2004) and B ( Jan. 2004- Dec. 2014). Patients with concomitant stricture urethra, vesical calculus/tumor and carcinoma prostate were excluded from the study. Patients were operated under good antibiotic cover. The demographic profile, operative findings, weight, biopsy and post op follow up for 6 months & the immediate and six months post operative complications were recorded. All patients in group B had urethral dilatation upto 27F, restricted resection time of 90 minutes, concomitant bilateral BNI in small glands (< 30 gms.), catheter care twice a day with betadine lotion and neosporin ointment & long term antibiotic prophylaxis in biopsy proven BPH with chronic prostatitis patients. Results: A total of 6800 patients were enrolled in Group A and 6986 in Group B. In the immediate postop period there was significant drop in TUR syndrome and clot evacuation (p > 0.01) in group B. In the late complications there is significant drop in the incidence of (Table presented) meatitis, meatal stenosis, stricture urethra & bladder neck stenosis (p > 0.001) in group B. Conclusions: TURP is still the gold standard of treatment for BPE and its morbidity can be reduced by simple measures like restricting resection time to 90 minutes, urethral dilatation before inserion of resectoscope, catheter care & concimitent BNI in glands of <30 gms.