Monopolar transurethral resection of the big prostate, experience at Prince Hussein Bin Abdullah Urology Center

To evaluate and review our experience in management of patients with big size prostate using monopolar transurethral resection of the prostate (TURP).

Between January 2005 and March 2010, TURP was performed on 198 patients with prostate size between 80 and 120 grams. The patients were subjected to standard urologic pre-operative evaluation and they were given 5 alpha reductase inhibitor for two weeks before surgery. TURP was performed using 27F continuous-flow resectoscope, Otis urethrotomy and suction cystostomy were done, and 500 ml normal saline with 20mg furosomide was given intraoperatively. Catheterization time, hospital stay, peri-operative and late complications were recorded. All patients were seen at 6 weeks and 6 months post surgery in the outpatient clinic. Symptoms and complications were evaluated and histopathological diagnoses were recorded.

The mean age was 67 +/- 3.7 years (range 57-80 years). Of these, 102 patients presented with retention and obstructive uropathy, 36 with recurrent haematuria, 12 with urinary bladder stones, 11 with recurrent urinary tract infection and 37 patients with moderate to severe international prostate symptom score (IPSS) and not responding to medical treatment. The mean prostate volume was 88 +/- 8.22 grams (range 80-120 grams) with an average residual urine of 160 ml (range 20-1500 ml). The mean Qmax was 6.8 +/- 1.7 ml/sec (range 2.1-11.7 ml/sec) and the mean IPSS score was 20.2 +/- 6.2 (range 15-30). The average operative time was 72 +/- 6.2 minutes (range 58-92 minutes). The mean drop in haemoglobin was 3.2 +/- 0.6 mg/dl (range 2.1-6.1 mg/dl) and immediate post-operative mean sodium drop was 3 +/- 1.36 mmol/l (range 0.9-13 mmol/l). Blood transfusion was needed in 17 patients (8.6%), two patients developed TURP syndrome (1%), and clot retention occurred in two patients (1%). The average time of hospital stay was 2.3 +/- 0.25 days, catheterization time was 48-72 hours, and re-catheterization was needed in three patients (1.5%). The mean IPSS score six weeks after surgery was 9.9 +/- 1.7 (range 6-21) and the mean Qmax was 18.1 +/- 2.1 ml/sec (range 6-22). Urethral stricture and bladder neck contracture occurred in 12 and 3 patients respectively (6 and 1.5%). Completion TURP was needed in four patients (2%).

Standard monopolar TURP with some modification in resection technique in addition to perioperative care will allow the urologist to treat benign prostate hyperplasia with prostate size between 80-120 grams successfully in centers where new laser technology is not available.