Introduction

Despite being frequently described as the gold standard treatment of benign prostate hyperplasia (BPH), transurethral resection of the prostate (TURP) has been recently challenged by other techniques as endoscopic enucleation, vaporization and incision of the prostate. Furthermore, TURP itself has been evolved by introduction of TURP in saline. The aim of our study was to determine independent predictors for procedure-related readmission (PRR) following transurethral interventions for BPH in a contemporary series.

Methods

The electronic files of our PIS were reviewed for all transurethral BPH interventions that were performed between 2005 and 2014. Patients with at least one depictable follow up were included. Files were reviewed for all perioperative and follow up data. PRR was reviewed for cause, management and time to primary intervention with assessment of readmission free survival (RFS) among different groups.

Results

Out of 3423 reviewed procedures 3020 were included for analysis. PRR was 262 (8.7%), 38 (1.3%) and 10 (0.3%) once, twice and three times following primary intervention respectively._x000D_ Causes of PRR and their management were summarized in table 1. _x000D_ Mean RFS (95%CI) was 102 (95:109), 117 (111:122), 73 (70:76) and 46.7 (44.7:48) months following incision, resection, enucleation and vaporization (P0.016) respectively._x000D_ Regardless energy used, on Cox regression analysis, RFS was independently predicted by surgical technique (HR 1.36, 95%CI 1.5:1.7, P0.02) and level of surgeon`s experience (HR 1.37, 95%CI 1.07:1.7, P0.01)._x000D_ The least depictable follow-up was 20 months. For prostate size less than 40ml; 20-month RFS was 97%, 89%, 93% and 87% following incision, resection, enucleation and vaporization (P0.01) respectively. Among cases with prostate size from 40 to 80ml; 20-month RFS was 80%, 97%, 95% and 89.8% following incision, resection, enucleation and vaporization (P0.02) respectively. Among cases with prostate size more than 80ml; 20-month RFS was 85%, 95% and 84% following resection, enucleation and vaporization (P0.04) respectively.

Conclusions

Regardless the kind of energy used, surgical technique dictates the need for readmission. Prostate incision achieves the best RFS for small sized prostate. While prostate resection or enucleation accomplish comparable high RFS in moderate sized prostate. When treating large sized prostate, least PRR seems to be with enucleation.

Funding

None