Learning Transurethral Resection of the Prostate: A Comparison of the Weight of Resected Specimen to the Weight of Enucleated Specimen in Open Prostatectomy

Abstract

Background: Minimally invasive procedures in the surgical management of benign prostate enlargement (BPE) are of limited use in the resource‑poor settings due to nonavailability of the requisite facilities and skills. It has been observed that teaching uroendoscopy inclusive of transurethral resection of the prostate (TURP) can be challenging in the resource‑poor settings where the traditional master‑apprentice (Halstedian) approach has remained the prevalent training technique. Patients and Methods: We aimed in this retrospective study to assess completeness of resection in TURP by comparing the proportion of prostate tissue resected to the proportion enucleated in open retropubic prostatectomy (ORP). We included all BPE patients on urethral catheter managed in the first 18 months after Halstedian training in TURP. The analysis was done using SPSS® 20 and VassarStats® online software. Results: Twenty patients’ files for TURP and twenty‑eight patients’ files for ORP met the inclusion criteria. Patients in the 2 treatment arms were similar in age (P = 0.22), body mass index (P = 0.45), proportion of prostate tissue extirpated (P = 0.38), and International Prostate Symptom Score 12‑month postprocedure (P = 0.06). However, larger prostates were treated with ORP (P < 0.0005). The correlation of the weight of resected specimen to preoperative prostate volume (PV) (r = 0.78; P < 0.001) was similar to that of enucleated specimen to preoperative PV (r = 0.89; P < 0.001). Similarly, the proportion of extirpated specimen correlated positively with the preoperative PVs for both TURP (r = 0.23; P = 0.33) and ORP (r = 0.292; P = 0.13), with no evidence of any difference between the 2 correlation values (P = 0.84). Conclusion: With appropriate patient selection, especially as a newly trained Surgeon, resections in TURP are as complete as enucleations in ORP.

Keywords: Correlation, enucleated weight, Halstedian approach, learning trans‑urethral resection of the prostate, resected weight, retropubic prostatectomy