Michael Seitz

PURPOSE: Transurethral resection of the prostate has for decades been the standard surgical therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia, the most common benign neoplasm in men. To generate a contemporary reference for evolving medical and minimally invasive therapies we analyzed complications and immediate outcomes of transurethral prostate resection in a statewide multicenter study. MATERIALS AND METHODS: We prospectively evaluated 10,654 patients undergoing transurethral prostate resection in the state of Bavaria, Germany from January 1, 2002 until December 31, 2003. Case records containing 54 items concerning preoperative status, operation details, complications and immediate outcome, were recorded for each patient. RESULTS: The mortality rate for transurethral prostate resection was 0.10%. The cumulative short-term morbidity rate was 11.1%. The most relevant complications were failure to void (5.8%), surgical revision (5.6%), significant urinary tract infection (3.6%), bleeding requiring transfusions (2.9%) and transurethral resection syndrome (1.4%). The resected tissue averaged 28.4 gm. Incidental carcinoma of the prostate was diagnosed by histological examination in 9.8% of patients. Urinary peak flow rate increased significantly to 21.6 +/- 9.4 ml per second (baseline 10.4 +/- 6.8 ml per second, 1 tail p <0.0001), while post-void residual decreased to 31.1 +/- 73.0 ml (baseline 180.3 +/- 296.9 ml, 1-tail p <0.0001). CONCLUSIONS: In a large scale evaluation comprising 44 mostly nonacademic urological departments in Bavaria, unique real-world data for transurethral prostate resection were prospectively generated. This most contemporary information should be of use to potential patients and facilitate subsumption of emerging surgical and nonsurgical benign prostatic hyperplasia treatment options.

PURPOSE: We prospectively analyzed the complications and immediate postoperative outcome of open prostatectomy for benign prostatic hyperplasia to provide reference data for emerging techniques, such as holmium laser enucleation of the prostate and laparoscopic prostatectomy. MATERIALS AND METHODS: A total of 902 patients with a mean +/- 1 SD age of 71.3 +/- 6.8 years were evaluated while undergoing open prostatectomy in Bavaria, Germany from January 1, 2002 to December 31, 2003. We prospectively analyzed 54 parameters concerning preoperative status, surgical details, complications and immediate outcome. RESULTS: Mean operative time was 80.8 +/- 34.2 minutes. Mean prostate size was 96.3 +/- 37.4 ml. Average enucleated tissue was 84.8 +/- 44.0 gm. Incidental carcinoma of the prostate was found in 28 of 902 patients (3.1%) and the mortality rate was 0.2%. The overall complication rate was 17.3%. The most relevant complications were bleeding requiring transfusion in 68 cases (7.5%), urinary tract infection in 46 (5.1%) and surgical revision due to severe bleeding in 33 (3.7%). Patients had an average International Prostate Symptom Score of 20.7 +/- 7.6 preoperatively. Mean urinary peak flow rate increased significantly to 23.1 +/- 10.5 ml per second from a baseline of 10.6 +/- 6.4 ml per second (p <0.0001). Post-void residual volume decreased to 17.5 +/- 34.8 ml from a baseline of 145.1 +/- 152.8 ml (p <0.0001). CONCLUSIONS: Open prostatectomy showed a satisfactory early postoperative outcome with a complication rate that was within the expected range compared to that in the recent literature. It represents an important option in the treatment of patients with significant benign enlargement of the prostate for surgeons with no access to modern techniques, such as holmium laser enucleation of the prostate or laparoscopy.