A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80 mL.

OBJECTIVES

We compared the safety and efficacy of transvesical prostatectomy (TVP) and transurethral resection of the prostate (TURP) for prostate greater than 80 mL in a prospective randomized trial.

METHODS

Eighty patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and assigned to TVP or TURP. Patients were assessed preoperatively and followed up at 3 and 12 months postoperatively. International prostate symptom score (IPSS), quality of life score (QoLS), maximum flow rate (Q(max)(.)), and postvoid residual volume (PVR) were obtained at each follow-up. Perioperative data and postoperative outcomes were compared. All complications were recorded.

RESULTS

Of 80 patients eligible to participate, 69 patients completed 12 months of follow-up. TURP procedure was not faster than TVP procedure (P = .41); 53.2% and 84.4% of prostatic tissue were resected after TURP and TVP, respectively (P < .001). In the TVP group, IPSS, Q(max)(.), QoLS, and PVR volume were significantly better than those in TURP group at 3 and 12 months of follow-up. At 12 months postoperatively, IPSS improved 87.6% and 62.3%, mean Q(max)(.) increased by 11.49 mL/s (230.2%) and 6.33 mL/s (102%), and mean PVR volume decreased by 71.2 mL (88.6%) and 65.4 mL (70.5%) in TVP and TURP group, respectively. Two TURP patients developed urethral stricture requiring reoperation.

CONCLUSIONS

TVP may be more effective and safer than TURP for the benign prostatic hyperplasia patient whose prostate volume is >80 mL.