Transurethral incision of the prostate: an objective and subjective evaluation of long-term efficacy

The emergence of less invasive therapies has demanded the reassessment of surgical procedures for the treatment of benign prostatic hyperplasia. This study was designed to evaluate the long-term efficacy of transurethral incision of the prostate using objective (urodynamic) and subjective (symptom score and assessment of satisfaction) parameters, and investigate sexual function. The results of transurethral incision of the prostate in 41 men (mean age 63.4 years) were reviewed, with a mean followup of 53 months (range 12 to 96). Preoperative symptom score (based on the Madsen-Iversen score) and urodynamic evaluation were compared to recent post-transurethral incision symptom score, urodynamic evaluation and interview to determine patient satisfaction. Total symptom score, as well as obstructive and irritative components, significantly decreased after transurethral incision of the prostate (p < 0.0001). Mean detrusor pressure at peak flow decreased from 85 to 44 cm. water (p < 0.0001) and mean maximal detrusor pressure decreased from 114 to 55 cm. water (p < 0.0001). Mean peak urine flow rates increased from 10.3 to 15.3 cc per second (p = 0.019). Of the men 32 (82%) reported long-term improvement after transurethral incision of the prostate, with an overall satisfaction rate of 67% (range 0 to 100). Regardless of objective urodynamic criteria (indicating obstruction or relief of obstruction), the number of men reporting subjective improvement and the degree of improvement were similar. Only 4 men (11%) reported new retrograde ejaculation. The proportion of men with improvement after transurethral incision of the prostate compares favorably to long-term data available on transurethral resection of the prostate. Assessing the degree of improvement (overall satisfaction) is unique and has not been previously reported. These results clearly demonstrate that in selected patients transurethral incision of the prostate is an effective procedure for long-term relief of outlet obstruction.