Transurethral incision of the prostate (TUIP) compared to transurethral resection of the prostate (TURP) in treating benign prostatic hyperplasia (BPH) patients with estimated prostatic weight of 50 grams or less : a randomized controlled trial

Abstract

Objective : To evaluate the difference in effectiveness between TUIP and TURP in BPH patients with estimated prostatic weight of 50 grams or less and to compare safety outcomes, complication rate, cost (patientʼs perspective) and cost-effectiveness at 12 weeks postoperatively. Design : A randomized controlled clinical study Setting : King Chulalongkorn Memorial Hospital Patients : 67 patients diagnosed of BPH with fulfillment of eligible criteria were enrolled in the study. The patients were randomly divided into TUIP group and TURP group. The TUIP group consisted of 33 patients and TURP group consisted of 34 patients. Intervention : Both groups were operated according to their groups by one urologist under general or spinal anesthesia. The IPSS symptom score, maximum flow rate, operation time, volume of irrigation fluid used, days with catheter, postoperative hospital stay, complication rate, and cost (patient's perspective) were measured up to 12 weeks postoperative. Results : Only 59 patients were completely follow-up for the clinical outcomes (39 patient in TUIP group and 29 patient in TURP group). The IPSS score was improved 14.3 points in TUIP group compared to 15.5 points in TURP group. There was no statistical significant difference. The improvement of maximum flow rate in TUIP group was 8.5 ml/sec compared to 13.2 ml/sec in TURP group. TURP was shown to cause more improvement in maximum flow rate than TUIP group. The operation time and the volume of irrigation fluid used in TUIP group were statistical significantly less than in TURP group. The periods of indwelling catheter and postoperative hospital stay were similar in both groups. The complication rates were also similar in both groups except retrograde ejaculation that TURP group has clearly more than TUIP group. The cost ( patient's perspective) was quite the same but cost-effectiveness analysis was still in favor of TURP. Conclusion : No difference in improvement of IPSS score between TURP and TUIP procedures. This subjective indicator is more important (especially to the patient) than objective indicator such as increase in urinary flow rate which shown to be more in TURP group. TUIP decrease the operation times and volume of irrigation fluid used significantly. However, the days with catheter, postoperative hospital stay, complication rate (except retrograde ejaculation) and cost were all similar in both groups. Cost-effectiveness analysis still favored TURP. In conclusion, TUIP may be used as an alternative to TURP in prostate size < 50 group with the same effectiveness but it cannot reduced complication and costs as we expected earlier.