Transurethral incision versus transurethral resection of the prostate in small prostatic adenoma: Long-term follow-up

Kader, O. A. Abd El; Den, Kanechika; Nashar, A. El; Hussein, Alaa A; Yehya, E.

doi:10.1016/j.afju.2012.04.007

Cited by 7 publications

(7 citation statements)

References 16 publications

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“…However, TUIP had a significantly lower rate of retrograde ejaculation (22.5%) and erectile dysfunction (7.5%) compared to TURP (52.5% and 20%, respectively). 10 Despite its retrospective nature, this study is noteworthy as it confirms the beneficial use of Ho-TUIP for selected patients with small prostates. The authors should be congratulated for this clever study and acknowledged for reminding us of this overlooked technique, which is also attractive, by its cost-effectiveness due to its shorter hospitalization stay and the use of reusable Holmium laser fibres.…”

Section: S Ince Its Initial Description In 1969 Bymentioning

confidence: 82%

Let’s not forget about TUIP: A highly underutilized, minimally invasive and durable technique for men with <30 g prostates

Hueber¹,

Zorn²

2015

CUAJ

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Benefits of TUIP include a low risk of perioperative morbidity, low incidence of retrograde ejaculation, shortened operative time, reduced postoperative bleeding -all coupled with the benefits of demonstrated short-term outcomes similar to transurethral resection of the prostate (TURP) for wellselected patients. A meta-analysis of short-and long-term data from 10 randomized controlled trials comparing TUIP with TURP found similar LUTS improvements and lower, but not significant, improvements in maximum flow rates for TUIP patients with small prostates, without enlarged prostate median lobes.5 There is also published data to support significantly lower bladder neck contracture rate for men undergoing TUIP when compared to TURP. 6 Despite these merits, TUIP remains underutilized in the urological community, possibly because of the concerns of the prostate size limitations, lack of transrectal ultrasonography to evaluate prostate volume prior to BOO surgery, reimbursement factors favouring TURP, and the question of long-term durability of success. Holmium TUIP (Ho-TUIP) has been previously described and used safely and effectively for small prostates even in high-risk anticoagulated patients. 7,8 In the current retrospective study of 80 patients, Elkoushy and colleagues demonstrate a durability of benefits with long-term 5-year follow-up in prostate volumes <30 cc. Interestingly, re-operated patients (11%) after Ho-TUIP had significantly larger prostate volume (36.8 ± 8.9 vs. 27.6 ± 5.1 cc, p < 0.001). Furthermore, the authors showed in a multivariate regression model that only prostate size independently predicted re-operation (adjusted odds ratio 95% confidence interval 7.12 [2.92-9.14], p = 0.01). Moreover, in a randomized study comparing TUIP and TURP in prostates <30 cc, the re-treatment rate was 7.5 % for both TURP and TUIP with slightly better IPSS and maximum flow rate, in favour of the TURP group. However, TUIP had a significantly lower rate of retrograde ejaculation (22.5%) and erectile dysfunction (7.5%) compared to TURP (52.5% and 20%, respectively).10 Despite its retrospective nature, this study is noteworthy as it confirms the beneficial use of Ho-TUIP for selected patients with small prostates. The authors should be congratulated for this clever study and acknowledged for reminding us of this overlooked technique, which is also attractive, by its cost-effectiveness due to its shorter hospitalization stay and the use of reusable Holmium laser fibres. Finally their findings also highlight the importance of using preoperative imaging, notably TRUS, to accurately assess prostate size before planning BPH surgery to select the most appropriate procedure. 11In concluding this editorial comment, we, the urological community, should ask the basic question: do men with small <30 cc volume prostates biologically have BPH? Or does their BOO stem from high, tight bladder necks? Not all prostates fit into the same "BPH bucket."

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Section: S Ince Its Initial Description In 1969 Bymentioning

confidence: 82%

Let’s not forget about TUIP: A highly underutilized, minimally invasive and durable technique for men with <30 g prostates

Hueber¹,

Zorn²

2015

CUAJ

View full text Add to dashboard Cite

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“…The reported RE rate was strongly in favor of TUIP, with 21% ( n = 14/67) versus TURP 73% ( n = 52/72, P < 0.0001). By adding the evidence of Abd‐El Kader RE remains significantly lower for TUIP, with an overall 21.1% ( n = 24/114) RE versus as much as 64.6% ( n = 73/113) in the TURP group …”

Section: Evidence Synthesismentioning

confidence: 96%

“…TUIP, first described by Orandi in the early 1970s, provides symptomatic improvement by splaying out the bladder neck without removal of tissue, and is suggested as a good alternative to TURP, especially in small glands . Several RCTs investigated TUIP versus TURP, reporting EjD as an outcome (Table ) . Clinical improvement of urinary symptoms and Q max were in favor of TURP in the majority of the studies, with three reporting no significant differences, whereas complications were generally lower for TUIP.…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Several RCTs investigated TUIP versus TURP, reporting EjD as an outcome (Table ) . Clinical improvement of urinary symptoms and Q max were in favor of TURP in the majority of the studies, with three reporting no significant differences, whereas complications were generally lower for TUIP. Preservation of normal ejaculation was significantly higher after TUIP in all the included trials, yielding approximately half of TURP EjD rates (overall = 28.2%, n = 26/92, range 0–35%).…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Preservation of normal ejaculation was significantly higher after TUIP in all the included trials, yielding approximately half of TURP EjD rates (overall = 28.2%, n = 26/92, range 0–35%). Differences with TURP are greater for smaller prostates (inclusion criteria PV <30 and <20 g respectively), with one study having only one in 14 patients, and one without any reported case of RE after TUIP …”

Section: Evidence Synthesismentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach?

et al. 2015

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Although ejaculatory dysfunction is common for patients undergoing benign prostatic hyperplasia surgery, no clear evidence is present to counsel men seeking to preserve ejaculation. Our aim was to evaluate ejaculatory dysfunction in relation to benign prostatic hyperplasia surgery. We carried out a web and manual search using MEDLINE and Embase including randomized controlled trials reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery: 42 randomized controlled trials comprising a total of 3857 patients were included. Only one study had ejaculatory dysfunction as a primary outcome, and just 10 evaluated ejaculatory dysfunction before and after surgery. The definition of ejaculatory dysfunction was not standardized. Similarly, just seven studies used internationally validated questionnaires to address ejaculatory dysfunction. The reported rates of ejaculatory dysfunction after resectional elecrosurgery, laser procedures, coagulation, ablation and implant techniques were assessed and compared. Transurethral resection of the prostate and recent laser procedures including holmium, thulium and GreenLight cause similar rates of ejaculatory dysfunction, occurring in almost three out of four to five men. Although providing less symptomatic benefit compared with transurethral resection of the prostate, transurethral incision of the prostate, transurethral needle ablation and transurethral microwave thermotherapy should be considered for men aiming to maintain normal ejaculation. UroLift is also a recent promising option for this category of patients. The vast majority of studies reporting ejaculatory dysfunction after benign prostatic hyperplasia surgery used poor methodology to investigate this complication. Future studies able to address clear hypothesis and considering ejaculatory dysfunction anatomical and pathophysiological features are required to develop ejaculation preserving techniques and to increase the evidence to counsel men aiming to preserve ejaculation.

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The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update

et al. 2020

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Transurethral incision versus transurethral resection of the prostate in small prostatic adenoma: Long-term follow-up

Cited by 7 publications

References 16 publications

Let’s not forget about TUIP: A highly underutilized, minimally invasive and durable technique for men with <30 g prostates

Let’s not forget about TUIP: A highly underutilized, minimally invasive and durable technique for men with <30 g prostates

Systematic review of lower urinary tract symptoms/benign prostatic hyperplasia surgical treatments on men's ejaculatory function: Time for a bespoke approach?

The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update

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