Transurethral Resection Of Prostate (TURP) And Transurethral Enucleation And Resection Of Prostate (TUERP): Pre And Postoperative Comparisons Of Parameters Used In Assessing Benign Prostatic Hyperplasia (BPH)

Purpose: Transurethral enucleation and resection of the prostate (TUERP) is believed to offer a better treatment for benign prostatic enlargement (BPE) by enucleating the entire adenoma. We compared the peri-operative parameters and outcome following conventional transurethral resection of the prostate (TURP) and TUERP.Materials and Methods: Data from two independent institutions were reviewed retrospectively; 50 consecutive patients who underwent conventional TURP were enrolled in TURP group (between January 2006 and February 2007), 45 consecutive patients who underwent TUERP were enrolled in TUERP group (between January 2005 and December 2006). The surgical indication for both groups was symptomatic benign prostate enlargement (BPE). Pre- and post-operative parameters, including Prostatic Specific Antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPSS), Quality of Life score (QOL), uroflowmetry, prostate volume (PV) and intravesical prostatic protrusion (IPP) on transabdominal ultrasound were compared.Results: Comparing TURP group and TUERP group, we found that the age at surgery (68.5±9.6 years versus 71.5±8.1 years), preoperative PSA (5.8±4.0 ng/ml versus 7.6±5.9 ng/ml) and PV (55.8±31.6 ml versus 53.2±26.8 ml) showed no significant difference (p>0.05). However, they differ significantly in the postoperative PSA and PV (2.8±3.0 mmol/L versus 0.8±0.4 mmol/L, p<0.05 and 15.2±7.7 gm versus 10.5±5.4gm, p<0.01, respectively). There was a good correlation between resected tissue weight (RTW) and resected volume (PVpre -op–PVpost-op) measured by ultrasound in TURP group (r=0.77). The mean resection time was shorter in the TUERP group [65.8±29.3 minutes versus 42.3±15.4minutes (p<0.01)]. The mean estimated resection rate [ERR= (PVpre -op–PVpost-op) / PVpre -op×100%] was more complete in the TUERP group [67.0% versus 76.8% (p<0.01)]. The mean follow-up was 19.8±10.0 months (TURP group) and 23.0±8.4 months (TUERP group), which without significant difference. There were no significant differences in IPSS, QOL, and Qmax between the two groups during follow up (p=0.62, 0.68 and 0.13 respectively). However, the postoperative PVR was significantly different (25.2±18.7 ml (TURP group) versus 13.8±19.5 ml (TUERP group); p<0.01).Conclusions: TUERP technique achieved more completed resection than TURP technique, with a smaller prostate volume and a reduced post-void residual urine volume after surgery. However, the improvement in symptomatology and uroflowmetry parameters was not significantly different. Post operative prostate volume and PSA may be used as an indicator of completeness of prostatic resection and therefore, may predict the outcome of TURP/TUERP. Longer term and larger studies are needed to validate these results.