Extraperitoneal Laparoscopic Adenomectomy (Madigan) versus Bipolar Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia Greater than 80 ml: Complications and Functional Outcomes after 3-Year Follow-up
Xie J, Tan Y, Wang F, Xuan Q, Sun Y, Xiao J, Zhu Y, Zhou L. J Endourol. 2013 Nov 14. [Epub ahead of print]


Anhui Provincial Hospital Affiliated to Anhui Medical University, Department of Urology, Hefei, China ; xiejinbo@hotmail.com.


Abstract Purpose: To compare the performance of voluminous benign prostatic hyperplasia (BPH) patients who have received laparoscopic simple prostatectomy (LSP) with the patients who have received bipolar transurethral resection of the prostate (B-TURP) in their perioperative and 3 years' follow-up period. Methods: 90 patients with prostate volumes greater than 80 ml (range 80-130 ml) randomly assigned to either LSP or B-TURP surgery types. The patients were followed up at 1, 3, 6, 12, 24, and 36 months postoperatively. Perioperative and follow-up characteristics were then recorded and compared. Results: More blood loss, greater resected adenoma volume and shorter catheterization duration were recorded in LSP group than that of B-TURP group (140.1±81.5 vs 93.1±54.0 ml; 65.3±13.8 vs 49.0±12.7 ml; 3.3±1.2 vs 3.8±1.0 d; P <0.05). None of patients in LSP group reported complications out of 30 days, while one case of urethral stricture, 36 cases of retrograde ejaculation, one case of bladder neck contracture and 2 cases of recurrence were recorded in B-TURP group. At 1, 3, 6 and 12 months postoperatively, there were no significant differences in terms of PVR, Qmax and I-PSS score between the two groups (P >0.05). In contrast, the differences became significant at 24 and 36 months (P <0.05). Conclusions: Compared with B-TURP, LSP with Madigan technique is accompanied by less residual adenoma, shorter catheterization time but more blood loss. What is more, the risk of late complications is lower with LSP, and in terms of functional outcomes LSP appears to be better than B-TURP beyond 2 years.