UDs may play a very limited role in detecting bladder outlet obstruction (BOO) in BPH patients with hypocontractile detrusor. TURP may obtain a promising effect on such patients with unidentified BOO. These patients should not be arbitrarily excluded from surgical indications simply based on UDs findings.

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Objectives• To compare the efficacy and safety of transurethral enucleation and resection of the prostate (TUERP) and transvesical prostatectomy (TVP) for patients with benign prostatic hyperplasia (BPH) and prostate volumes >80 mL. Patients and Methods• A total of 100 patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and enrolled in the study at a tertiary hospital. • Patients underwent TVP or TUERP performed by one of two surgeons with experience of a large number of cases.• All patients were preoperatively evaluated using patient age, prostate volume measurement, clinical characteristics of digital rectal examination, self-assessment using the International Prostate Symptom Scores (IPSS) questionnaire, a quality-of-life (QoL) questionnaire, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), urine analysis, blood sample analysis, including determination of prostate-specific antigen (PSA) and haemoglobin concentration. • All patients were assessed peri-operatively and postoperatively at 3 and 12 months. All complications were documented. Results• Of 100 patients eligible to participate, 92 patients completed 12 months of follow-up.• Patients who underwent TUERP had shorter catheterization times and hospital stays. Operation duration was not significantly different between the two surgical groups (P = 0.107).• The resected adenoma weight in the TVP group was more than that in the TUERP group, but the difference was not significant (P = 0.062).• There were no significant differences in IPSS, PVR, Qmax or QoL scores between the groups at 3 and 12 months. The patients in the TVP group appeared to have a better Qmax at 3 months, however, the difference was not significant (P = 0.081).• Adverse events were similar in the two groups. Conclusion• We found that TUERP had efficacy and safety equivalent to that of TVP for patients with BPH and prostate volume >80 mL.