Minimal Transurethral Prostatectomy plus Bladder Neck Incision versus Standard Transurethral Prostatectomy in Patients with Benign Prostatic Hyperplasia: A Randomised Prospective Study

Objective: To evaluate the effectiveness and complications of the combination of minimal transurethral resection of the prostate and bladder neck incision in comparison with those of the standard transurethral resection of the prostate (TURP). Patients and Methods: Forty patients with prostates of ≤25 ml were randomized to two equal groups (20 cases in each). In group I minimal transurethral resection of the prostate followed by bladder neck incision at the 6 o’clock position and in group II standard TURP were performed. Patients were evaluated in terms of the change in symptom severity, maximal flow rate and sexual function in addition to operating time, length of hospital stay, problems of catheter positioning at the end of the operation and the rate of bladder neck contracture using χ 2 and independent t tests. Results: Age, prostate volume postoperative follow-up time, improvement in international prostate symptom score and maximal flow rate, length of hospital stay and erectile dysfunction rates were not statistically different between the 2 groups. Operation time was shorter in group I (p = 0.001). Although the urethral catheter was easily positioned at the end of the operation in group I, it was not possible in group II for 4 patients (p = 0.053). Postoperative retrograde ejaculation for groups I and II were determined in 7 and 16 patients, respectively (p = 0.005). Bladder neck contracture was not found in group I, while it was seen in 2 patients in group II (p = 0.487). Conclusion: The combination of minimal transurethral resection and bladder neck incision in patients with small prostates appears to provide a satisfactory clinical outcome, comparable with standard TURP, while preventing the difficulty of urethral catheter positioning at the end of the operation, decreasing bladder neck contracture and lowering the incidence of retrograde ejaculation.