Safety and Efficacy of Middle Lobe Transurethral Resection in Patients with Benign Prostatic Hyperplasia

Abstract

Background: Unfortunately, the conventional transurethral prostate resection approach is associated with loss of antegrade ejaculation in about 65 to 80 % of patients. Loss of ability to ejaculate is by far the most common concern in relatively young men with benign prostatic hyperplasia undergoing standard transurethral resection procedure. The aim of the study was planned and carried out in order to compare the outcome of ejaculatory preserving middle lobe TURP with that of the standard TURP in a groups of relatively young Iraqi patients (< 65) with benign prostatic hyperplasia.

Methods: The current comparative prospective study was carried out in the urology department of Hilla Teaching Hospital, Babel province, Iraq. The study included a total of 60 men with symptomatic benign prostatic hyperplasia, 30 of them underwent middle lobe only TURP and the remaining patients underwent standard whole TURP. The groups were followed up for one year for principal outcome of erectile dysfunction and preservation if antegrade ejaculation.

Results: The duration of operation was significantly less in middle lobe TURP in comparison to that of standard whole TURP (P <0.05). The frequency of men with erectile dysfunction was significantly less in middle lobe TURP in comparison to that of standard whole TURP (P <0.05). The frequency of men with preservation of ejaculation was significantly higher in middle lobe TURP in comparison to that of standard whole TURP (P <0.05). There was no significant difference in mean IPSS, Q max and PVRU between both groups (P > 0.05), despite being better in standard whole TURP.

Conclusion: Middle lobe TURP appears more appropriate for mean < 65 years of age with prominent middle lobe benign prostatic hyperplasia in terms less operative time, less frequency of postoperative erectile dysfunction and preservation of ejaculation in comparison to standard whole TURP.