Elsevier

Urology

Volume 64, Issue 2, August 2004, Pages 306-310
Urology

Adult urology
Long-term results of open transvesical prostatectomy from a contemporary series of patients

https://doi.org/10.1016/j.urology.2004.03.033Get rights and content

Abstract

Objectives

To provide information about the long-term efficacy of transvesical prostatectomy from a contemporary series of patients. When comparing minimally invasive procedures with open prostatectomy, the data for the latter are usually provided from old studies or from recent ones performed in developing countries. However, this procedure is still used frequently for large-size prostates.

Methods

During a 5-year period, 232 patients with large (greater than 75 g) prostates underwent open transvesical prostatectomy for symptomatic benign prostatic hyperplasia. Patient charts were retrospectively reviewed for preoperative and postoperative International Prostate Symptom Scores, postvoid residual urine volumes, maximal flow rates, early and late postoperative complications, and the need for reoperation. The preoperative International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate were compared with the corresponding postoperative data at 8 to 12 months and at the last follow-up visit.

Results

Complete data evaluation was possible for 151 patients, with a mean follow-up of 41.8 ± 15.6 months. Improvement in International Prostate Symptom Score, postvoid residual urine volume, and maximal flow rate was statistically significant (P <0.001) at 8 to 12 months and remained statistically significant at the last follow-up visit. Long-term complications included bladder neck contraction in 5 (3.3%) occurring at a mean of 10 months (range 5 to 17), urethral strictures in 1 (0.6%), and meatal stenosis in 2 (1.3%) of 151 patients. Re-operation was required in 6 patients (3.9%).

Conclusions

Transvesical prostatectomy in a contemporary series of patients proved to be successful, with a low rate of complications. Its success has a durable effect and only rarely was a corrective procedure necessary. This approach should be included in the list of possible treatments to discuss with the patient with a large prostate.

Section snippets

Material and methods

From January 1997 to December 2001, 270 patients underwent open transvesical prostatectomy in a single hospital by one senior attending surgeon. The indications for surgical management were complications and/or bothersome lower urinary tract symptoms attributed to BPH. Thirteen patients diagnosed with incidental prostate cancer in the final pathologic examination were excluded from the study, even if the focus was single and/or of low grade. Twenty-five patients with prostates smaller than 75 g

Results

The characteristics of the 232 men who underwent simple open prostatectomy for a prostrate gland greater than 75 g are shown in Table I . The average length of hospital stay was 6 ± 0.9 days (range 4 to 10). Catheter removal was possible at an average of 5 ± 0.9 days (range 4 to 10). No postoperative mortality was seen in this series of patients. Early postoperative complications are also presented in Table I.

Lower urinary tract symptoms and the quality of life question from the IPSS

Comment

Open simple prostatectomy is the oldest therapy for symptomatic BPH.11 Even though the mortality of this procedure has decreased to a minimum,12 mainly owing to the advent of better preoperative evaluation and anesthesia, and the therapeutic results obtained have been excellent,13 this procedure has been displaced by TURP, mainly because of its invasiveness.

However, in several countries, open prostatectomy still has a role in the management of BPH. In underdeveloped countries, the selection of

Conclusions

Transvesical prostatectomy in a contemporary series of patients proved to be successful, with a low rate of complications and blood loss. Its success has a durable effect and only rarely was a corrective procedure necessary. This approach should be included in the list of possible treatments to discuss with patients with a large prostate gland.10

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