Abbreviations & AcronymsObjectives: Our center has adopted a protocol for catheter-free first postoperative day discharge after bipolar transurethral resection of the prostate. We present the immediate, 1-month and 6-month outcomes of our first 100 cases following this protocol. Methods: All bipolar transurethral resection of the prostate patients followed the protocol regardless of indications and background comorbid conditions. Bladder irrigation was stopped in the evening after transurethral resection of the prostate, and the catheter was removed at 06.00 hours. All patients were discharged on the first postoperative day. They were reviewed at 1 month and 6 months with the International Prostate Symptom Score and uroflowmetry. Results:The mean age of the study population was 70.8 years. A total of 40 patients had urinary retention and were on an indwelling catheter before transurethral resection of the prostate. A total of 14 patients had other surgeries in the same setting as the transurethral resection of the prostate. The mean resection weight was 32.7 g. The mean irrigation time and catheter time were 4.2 h and 15.0 h, respectively. The improvement in terms of International Prostate Symptom Score, quality of life score, peak flow rate and post-void residual volume was comparable with those reported in the literature for bipolar transurethral resection of the prostate. Similarly, early and late complication rates also compared favorably with the literature. The perioperative cost was significantly reduced. Conclusions: Catheter-free first postoperative day discharge after bipolar transurethral resection of the prostate is safe with good clinical outcomes and cost savings.

Medical therapy for clinical benign prostatic hyperplasia (BPH) has advanced significantly in the last 2 decades. Many new α1 antagonists and 5α reductase inhibitors (5ARi) are now commercially available. The practicing urologist must decide on the most appropriate medication for his patients, taking into consideration various factors like efficacy, dosing regime, adverse effects, cost, patient's socioeconomic background, expectations, drug availability and his own clinical experience. The use of combination therapy added further to the complexity in clinical judgment when prescribing. We highlight some of the key points in prescribing α1 antagonists, 5ARi and their combination, based on our viewpoints and experience as urologists in an Asian clinical setting.

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Objective: Circumcision wounds are commonly dressed with paraffin gauze dressings. Octylcyanoacrylate tissue adhesive (Dermabond; Ethicon, US) is increasingly being used for wound closure, as well as wound dressing. This study compared the outcomes of tissue adhesive dressing versus paraffin gauze dressing for circumcision wounds. Method: Adult male patients undergoing circumcision were randomised into two groups: tissue adhesive dressing (study group) or paraffin gauze dressing (control group). They were followed up at two weeks and at two months after surgery. The primary objective of this study was to determine the difference in patient-reported dressing satisfaction at two week follow-up. Our secondary outcomes included operation time, postoperative pain, postoperative complications, patient-reported cosmetic satisfaction, surgeon-reported cosmetic satisfaction, and surgeon-reported objective measure of cosmetic outcome using a validated scale. Results: A cohort of 40 patients was randomised into two equal groups, study and control. Tissue adhesive dressing was associated with a significantly better patient-reported dressing satisfaction, with a mean Likert scale score of 4.53±0.51 for the study group versus 3.20±1.24 for the control group (p<0.001). It was also associated with a significantly better patient-reported cosmetic satisfaction of 4.58±0.51 versus 4.00±1.12 (p<0.05), respectively. There was no difference in operation time, postoperative pain, postoperative complications or surgeon-reported cosmetic outcomes. Conclusion: Tissue adhesive dressing is an acceptable alternative to paraffin gauze dressing for circumcision wounds. This option should be offered to all patients undergoing circumcision.