Abstract
Objective: To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months. Patient and Methods: The study was conducted in Department of General Surgery in Maulana Azad Medical College, New Delhi. 60 men with proven clinical diagnosis of BPH of size 30 grams and less presenting with symptoms of bladder outlet obstruction (BOO) were randomised prospectively to undergo either of the two operative modalities. Preoperatively size of the prostate, symptom scoring (IPSS), peak flow rate (Qmax) were assessed. Postoperatively and during 4 months follow up the following data were collected—operative time, catheterisation period, hospital stay, blood loss, Qmax and IPSS. Results: Preoperative parameters in both the groups showed no statistically significant differences with respect to prostate size, Qmax and IPSS Scoring. At 4 months follow up Qmax increased from (6.35 ± 4.49) to (16.41 ± 2.28) in TURP group and (4.51 ± 3.57) to (15.95 ± 2.58) in BNI group. IPSS decreased from 18.70 to 5.7 in TURP group and 18.90 to 6.00 in BNI group. All differences were statistically significant. There was a statistically significant difference in operative time, blood loss, hospital stay, catheterisation timing favouring BNI. Conclusion: TURP and BNI are equally effective in providing symptomatic improvement. BNI has an upper hand in reference to operative time, hospital stay, duration of catheterisation and blood loss.
Highlights
Surgical treatment of benign prostatic hyperplasia (BPH) is classically by transurethral resection of prostate (TURP) and is the gold standard in treatment of symptomatic BPH which has withstood the test of time [1]
To compare the efficacy of bladder neck incision (BNI) with transurethral resection of prostate (TURP) in the treatment of patients with urinary obstruction caused by benign prostatic hyperplasia (BPH) on the basis of short term follow up of 4 months
Maximum flow rates have improved significantly after both procedures(p < 0.05) and interestingly there was a statistical significant difference in the percentage change from pre-operative status of peak flow rate in Bladder neck incision (BNI) group (207.91% ± 153.89% in BNI group compared to 95.25% ± 40.99% in TURP group) as evidenced by p value of 0.048. These results indicate that TURP and BNI, both are effective in relieving symptoms and improving urinary flow rates (BNI having an upper hand in the later)
Summary
Surgical treatment of BPH is classically by TURP and is the gold standard in treatment of symptomatic BPH which has withstood the test of time [1]. In the last two decades, the role of TURP as gold standard therapy for patients with LUTS due to BPH has increasingly been challenged by the development of medical (5 alpha reductase inhibitors, alpha 1 receptor blockers) and less invasive interventional alternatives. It has been asserted that BNI is an underused procedure [3] and at least half of the patients who currently undergo TURP for small BPH causing obstruction can be treated effectively with BNI thereby avoiding many of the risks of the former procedure [4]. It did not gain popularity due to emerging techniques like HoLEP
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