1. Department of Urology, Guangzhou First Municipal People’s Hospital, Guangzhou Medical College, Guangzhou, China Rubiao Ou, Meng You, Ping Tang, Hui Chen, Xiangrong Deng, and Keji Xie PGY 外科 R1 許祐仁

2. Introduction The surgical management of patients with large prostate (>80 mL) that cause bladder outflow obstruction (BOO) secondary to benign prostatic hyperplasia (BPH) is a challenging area. To address the safety and efficacy of transvesical prostatectomy (TVP) and TURP for prostate >=80 mL, this paper reports the 12 months of follow-up results of a randomized trial comparing TVP with TURP.

3. Materials and Methods  Urology Department, the Guangzhou First Municipal People’s Hospital, between December 2007 and June 2009.  The indications for prostatectomy include: acute urinary retention, recurrent or persistent urinary tract infections, significant symptoms from bladder outlet obstruction not responsive to medical therapy, recurrent gross hematuria of prostatic origin, pathophysiologic changes of the kidneys and ureters secondary to prostatic obstruction

4. Materials and Methods  Exclusion criteria were: previous prostate or urethral surgery and voiding disorders not related to benign prostatic hyperplasia (BPH) (eg, neurogenic bladder disorder), if indicated; prostate carcinoma was excluded by biopsy.

5. Materials and Methods  Pre-op evaluation: Digital rectal examination; Urine analysis; Transrectal ultrasound (TRUS) measurement of the prostate=0.52 (L*W*H)ml  >80 ml Blood sample analysis, including determination of prostate-specific antigen (PSA); Maximum flow rate (Qmax); Postvoid residual assessment (PVR), International Prostate Symptom Score (IPSS).

6. Results  Eighty eligible patients were randomly assigned to either TVP (n=40) or TURP (n=40).  Ten patients refused to receive the allocated procedures (6 patients assigned to TVP, 4 patients assigned to TURP).  One patient was lost to follow-up at 3 months in the TURP group because of moving abroad.  A total of 69 (86.2%) patients (TVP, n=34; TURP, n=35) completed 12 months of follow-up and data were available and analyzed.

7. Results

11. Conclusions  TVP may be more effective and safer than TURP for the BPH patient whose prostate volume is >80 mL within 12 months of follow-up.

12. Editorial Comment  Slow resection time (mean operating time 103.7 minutes, mean resected weight 69.7 gm). Most of us can resect at a rate of a gram per minute.  In addition, postoperative catheterization (4.1 days) and hospitalization (5.6 days) were unusually long.  The authors do not discuss sexual side effects. new onset ejaculatory dysfunction would be significant in the open prostatectomy group  Large prostates remained ideal candidates for open prostatectomy.