Publication:

Comparative evaluation of different modalities of treatment in benign prostatic hyperplasia at tertiary care teaching institute

Background Benign prostatic hyperplasia (BPH) is the most common disease occurring in men as the age advances. There are various treatment modalities available, amongst which trans-urethral resection of prostate (TURP) is widely used but role of open Freyer's prostatectomy and medical management can't be ignored at the same time. This study was done to compare different modalities of treatment, to evaluate the individual modality in view of its efficacy, complications and patient satisfaction, to compare the different modalities in their efficacy for management of BPH and their complication profile, to suggest the best form of therapy that can be offered to patients.

Methods A retrospective comparative study was conducted including 90 patients having benign prostatic hyperplasia (BPH) were enrolled for the study and randomly divided into three groups of 30 patients each. Group I consists of patients undergoing for Freyer's prostatectomy, Group II consists of patients undergoing TURP and in Group III patients were managed conservatively with medical management.

Results Temporary Incontinence of urine was the most common complication occurred found in 6 cases (20%) in Freyer’s prostatectomy group I and in 3 cases (10%) in TURP group II; per-urethral catheter was removed between 2-5 days in all 30 cases (100%) of TURP, but in Freyer’s prostatectomy it was kept up to average 10 days (8-18); All 30 cases (100%) of in Group II where TURP done were discharged within 6 days of surgery whereas in Group I where Freyer's prostatectomy done, most of the cases 21 (70%) were discharged between 11-15 days post-operatively. In Group III, patients were managed by medical management patients, 11 cases (36.67%) presented with acute urinary retention (AUR)     and 19 (63.33%) patients presented with lower urinary tract symptoms (LUTS) without retention.

Conclusions TURP is having definite advantage over Freyer's prostatectomy, because Length of hospitalization, postoperative complications are less frequent. Transurethral resection is the method of choice in the treatment of benign prostatic hyperplasia especially in patients with mild to moderate prostatic enlargement and in the elderly patients with co-existing medical disease. Endoscopic instruments, training and more experience is required for TURP. Medical management can delay immediate surgery but later on surgical management is usually required.