Prostatectomy or conservative management in the treatment of benign prostatic hypertrophy?

A randomised, prospective trial comparing transurethral prostatectomy with conservative management was carried out in 38 men with proven bladder outflow obstruction. Patients were assessed urodynamically before treatment and 6 months later. All 21 patients who had a prostatectomy showed a significant improvement in peak flow rate, voiding pressures and residual urine volume, but only 71% were symptomatically better. Of the 17 patients treated conservatively, 56% noted an improvement in their symptoms, although their peak flow rates and residual urine volume were virtually unchanged. Following prostatectomy, the incidence of detrusor instability fell by 78%, whereas in the conservatively treated group the reduction was only 50%. Patients who had done well or badly after treatment were analysed as separate subgroups. The single feature which distinguished between these two groups was the high incidence of reversion to bladder stability in those who had a good symptomatic response to treatment.