Transurethral resection versus transurethral incision of the prostate

A new operation, transurethral incision of prostate (TUIP), performed on 846 patients in 20 years, is offered primarily for the management of bladder outlet obstruction in young, middle-aged, and those old men with small prostates who otherwise would be subjected for years to dilatation, massage, and drugs with only partial and temporary relief. In matched cases, results and complications are the same for TUIP and TURP except for the troublesome bladder neck contracture and the higher incidence of reflex into the seminal vesicles and sexual complications after resection of the prostate. Transurethral incision is unsuitable for large prostates. As for economics, compassion and wisdom in fee collection are justified. Cost reduction in health care may be necessary, but it hurts everyone involved. There is no such thing as unnecessary surgery when the critics are charged with decision making about the health and life of the patient before surgery. Finally, before the advent of the third-party payment, operations were avoided because of the financial burden. The surgeon, the patient, and the relatives silently consented to no care. This "silent consent" did not improve the quality of life but did contain costs--as well as longevity.     

Transurethral incision versus transurethral resection of the prostate. A subjective and objective analysis.

A prospective study was undertaken comparing transurethral incision of the prostate (TUIP) with transurethral resection (TURP) in the treatment of 220 patients with urinary obstruction caused by a small, benign prostate. Patients were managed alternately by TUIP and TURP, and their symptoms and urodynamic findings evaluated before and after surgery. Subjectively and objectively, the results were comparable in both groups. Pre- and post-operative complications were significantly less for the TUIPs than the TURPs. TUIP was significantly better than TURP in terms of shorter operating time, duration of hospitalisation and reduced need for transfusion. We recommend TUIP as the operation of choice for the relief of obstruction in the presence of a small, benign prostatic enlargement.     

A prospective randomized study of combined visual laser ablation and transurethral resection of the prostate versus transurethral prostatectomy alone

INTRODUCTION: Visual laser ablation of the prostate (VLAP) has a clinical failure rate of up to 18% which is 3 times higher than transurethral resection of the prostate (TURP) alone. Prolonged spontaneous passage of necrotic debris is the major shortcoming of this method. Therefore combined visual laser-assisted and transurethral prostatectomy was compared to TURP alone. MATERIALS AND METHODS: 105 patients were evaluated in a prospective randomized study comparing TURP alone and VLAP combined with TURP. The patients were evaluated 1, 3 and 12 months after surgery. First VLAP was performed using a neodymium:yttrium-aluminum-garnet laser with the prolase fiber followed by standard resection of the necrotic and remaining prostatic tissue. Treatment efficacy was assessed by the American Urological Association (AUA) symptom score, measurements of peak urinary flow, residual urine volume, intraoperative bleeding, and by the occurrence of intra- and postoperative complications. RESULTS: The use of VLAP and consecutive TURP improved the AUA symptom score, urinary flow and residual volume and was comparable in all patients treated. Intraoperative bleeding was significantly reduced from 522 +/- 45 ml by TURP to 214 +/- 33 ml by VLAP+TURP (p < 0.05). There was a significant improvement in the postoperative values of the parameters observed in both groups. CONCLUSIONS: It appears that the combined method for treatment of benign prostatic hyperplasia reduced the specific intraoperative morbidity of TURP while achieving the same clinical effect as TURP alone.     

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

ObjectivesTo evaluate the efficacy of transurethral incision of the prostate (TUIP) compared to transurethral resection of the prostate (TURP) in patients with small benign prostate adenoma, based on long-term follow-up.Patients and methodsWe prospectively randomized 86 men with bladder outlet obstruction symptoms caused by a prostate less than 30 g to undergo TUIP or TURP. The following preoperative parameters were evaluated: prostate weight, international prostate symptom score (IPSS), voided volume, maximum flow rate (Qmax) and post-void residual volume (PVR). Postoperatively the patients were followed up for 48 months and the following data were collected: morbidity, operative time, catheterization period, hospital stay, Qmax, IPSS, voided volume, PVR and reoperation rate.ResultsA total of 80 of the 86 patients completed the study: 40 patients in each group. The mean age of patients in group I (TURP) and group II (TUIP) was 63.6 and 66.2 years, respectively. Preoperative parameters in both groups showed no statistically significant differences with regard to uroflow parameters and prostate weight. At 48 months follow-up the mean voided volume increased from 161 ml to 356 ml in group I and from 161 ml to 341 ml in group II, Q-max increased from 8.4 to 18.4 in group I and 8.4 to 16.6 in group II, the IPSS decreased from 19 to 5.8 in group I and from 19 to 6.3 in group II and PVR decreased from 107 ml to 20 ml in Group I and from 109 ml to 21 ml in Group II (all differences statistically significant). Comparing groups I and II there were statistically significant differences with regard to mean operative time (60.0 versus 20.6 min), duration of catheterization (3.2 versus 2.2 days), hospital stay (3.7 versus 2.6 days), and the incidence of postoperative retrograde ejaculation (52.5% versus 22.5%) and erectile dysfunction (20% versus 7.5%).ConclusionTUIP and TURP for small prostatic adenoma of less than 30 g are equally effective in providing symptomatic improvement. TUIP is more advantageous with to side-effects, operative time, hospital stay and the duration of catheterization.     

Rotoresection versus transurethral resection of the prostate: short-term evaluation of a prospective randomized study

PURPOSE: We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate. MATERIALS AND METHODS: A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean+/-SD patient age was 60.76+/-5.85 years in the rotoresection and 64.24+/-6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer's grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis. RESULTS: At 6 months International Prostate Symptom Score decreased from 26.2+/-4.06 to 5.32+/-1.52 in the rotoresection group and from 22.84+/-4.56 to 7+/-1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87+/-2.24 to 25.29+/-10.39 ml per second in the rotoresection group and from 9.44+/-2.29 to 25.2+/-5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2+/-16.58 to 17.24+/-7.61 ml in the rotoresection group and from 40.6+/-16.93 to 18.28+/-8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84+/-26.8 cm H2O and 4.24+/-0.97 to 38.8+/-18.8 cm H2O and 1.24+/-0.93 in the rotoresection group, and from 63.04+/-21.08 cm H2O and 3.48+/-0.65 to 34.16+/-12.7 cm H2O and 1+/-0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p=0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group. CONCLUSIONS: Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.     

Transurethral holmium laser enucleation of the prostate versus transurethral electrocautery resection of the prostate: a randomized prospective trial in 200 patients

PURPOSE: Transurethral electrocautery resection (TURP) is generally regarded as the gold standard surgical treatment for bladder outflow obstruction due to benign prostatic hyperplasia despite its rather high morbidity. The high powered holmium:YAG laser can be used endoscopically to enucleate obstructing prostatic tissue in a relatively bloodless manner. The technique of transurethral holmium laser enucleation of the prostate (HoLEP) was compared to standard TURP for the surgical management of prostate adenomas in a randomized, prospective clinical trial. MATERIALS AND METHODS: A total of 200 urodynamically obstructed patients with a prostate of less than 100 gm on transrectal ultrasound were randomized to HoLEP or TURP. All patients were assessed preoperatively, and 1, 6 and 12 months postoperatively. Patient baseline characteristics, perioperative data and postoperative outcome were compared. All complications were noted. RESULTS: HoLEP was significantly superior to TURP in terms of catheter time, hospital stay and hemoglobin loss but operative time was longer. HoLEP and TURP resulted in a significant improvement in American Urological Association symptom scores, peak urinary flow rates and post-void residual urine volumes with symptoms scores and residual volume significantly better in the holmium group. Effects on continence and potency were similar in the 2 groups but adverse events were less frequent in the holmium group. CONCLUSIONS: HoLEP and TURP are highly effective procedures for removing obstructing prostatic adenomas. HoLEP resulted in significantly better micturition parameters and less perioperative morbidity.     

剥离式经尿道前列腺切除术与经尿道前列腺电切术治疗良性前列腺增生的比较研究

目的:比较经尿道前列腺电切术(TURP)与使用专用前列腺增生腺体剥离器行剥离式经尿道前列腺切除术(剥离式TURP,TUERP)治疗良性前列腺增生(BPH)的疗效与安全性。方法:BPH患者630例,均具备手术指征,随机分为TURP组(305例)和剥离式TURP组(325例)。术前两组年龄、前列腺体积、国际前列腺症状评分(IPSS)、最大尿流率(Qmax)数值比较,差异无统计学意义(P均0.05)。记录两组手术时间、手术切除率、术后需要持续膀胱冲洗时间、术后生活质量评分(QOL)、手术并发症数据,进行统计学分析。结果:手术后的资料分析显示,TUERP手术切除率优于TURP组的手术切除率[(60.1±12.3)%vs(47.0±13.3)%,P0.05)];TUERP组平均手术时间比TURP组短[(40.4±14.2)min vs(57.9±15.9)min,P0.05];术后冲洗时间较短[(2.2±1.1)d vs(2.7±0.6)d,P0.05]。TUERP组手术前后血清Na+和血红蛋白浓度变化无统计学意义,TURP组血清Na+和血红蛋白浓度变化有统计学意义[血Na+:(141.2±3.5)mmol/L vs(136.9±4.7)mmol/L,P0.01,血红蛋白:(137.6±8.8)g/L vs(124.8±9.6)g/L,P0.01]。术后3个月,两组的IPSS评分、QOL评分、Qmax评分均较术前有显著改善(P均0.01),组间比较无显著性差异。(P0.05)。结论:剥离式TURP治疗BPH和TURP比较,具有手术时间短、手术切除率高、术中出血少、术后恢复快、并发症少等优点,在临床上有良好的应用前景。     

Interstitial laser coagulation versus transurethral resection of the prostate for benign prostatic enlargement--a prospective randomized study

OBJECTIVE: Interstitial laser coagulation (ILC) of the prostate is a minimally invasive method for treating symptomatic benign prostatic enlargement (BPE). We performed a prospective randomized study to compare the clinical outcomes of ILC and transurethral resection of the prostate (TURP). MATERIAL AND METHODS: Between December 1997 and February 2000, 38 patients with moderate-to-severe symptomatic BPE were included in the study. Seven were subsequently excluded due to intercurrent disease or protocol violation and the remaining 31 were randomized to either TURP (n=11) or ILC (n=20). A suprapubic tube was inserted in all ILC-treated patients, and ILC was performed as an outpatient procedure when feasible. Data were recorded preoperatively and at 3-month and 1-year follow-up. The assessment parameters were International Prostate Symptom Score (IPSS), uroflow, prostate volume determined by means of transrectal ultrasound and postvoid residue. RESULTS: At 1-year follow-up, uroflowmetry indicated a more pronounced increase in peak urinary flow rate (Qmax) in the TURP patients than in the ILC subjects (p<0.02). Differences in postvoid residue, IPSS and prostate volume between the two treatments could not be evaluated due to the small number of patients in each group. Postoperative urinary tract infections occurred in 13 ILC patients but in only one TURP subject, and catheterization was done for 24 days after ILC and for 2 days after TURP. The study was ended prematurely due to the prolonged postoperative catheterization and the high rate of urinary tract infections in the ILC patients. CONCLUSIONS: At 1-year follow-up, the increase in Qmax was smaller in the ILC subjects than in the TURP patients. The ILC subjects had comparatively more postoperative urinary tract infections and more prolonged postoperative catheterization than the TURP patients.     

Transurethral incision of prostate compared with transurethral resection of prostate in 132 matching cases

In a prospective project during a 2-year period 132 patients with bladder outlet obstruction who were candidates for transurethral incision of the prostate were managed alternately by transurethral incision and transurethral resection of the prostate. Both operations were compared in matched patients. The results and complications favored transurethral incision, although there was no statistical significance except for the high incidence of bladder neck contracture after transurethral resection (p equals 0.028).     

Thulium laser versus standard transurethral resection of the prostate: a randomized prospective trial

OBJECTIVE: Thulium laser resection of the prostate-tangerine technique (TmLRP-TT) is a transurethral procedure that uses thulium laser fiber to dissect whole prostatic lobes off the surgical capsule, similar to peeling a tangerine. To our knowledge we report the first prospective, randomized study comparing TmLRP-TT and standard TURP for symptomatic BPH. METHODS: From November 2004 to December 2005, 100 consecutive BPH patients were randomized for surgical treatment with TmLRP-TT (n=52) or TURP (n=48). All patients were preoperatively assessed with subjective symptoms score, International Index of Erectile Function questionnaire, and complete urodynamic evaluation. Preoperative and perioperative parameters at 1-, 6-, and 12-mo follow-up were also evaluated. All complications were recorded. RESULTS: TmLRP-TT was significantly superior to TURP in terms of catheterization time (45.7+/-25.8h vs. 87.4+/-33.8h, p<0.0001), hospital stay (115.1+/-25.5h vs. 161.1+/-33.8h, p<0.0001), and drop in hemoglobin (0.92+/-0.82 g/dl vs. 1.46+/-0.65 g/dl, p<0.001), whereas it required equivalent time to perform (46.3+/-16.2 vs. 50.4+/-20.7 min, p>0.05). TmLRP-TT and TURP resulted in a significant improvement from baseline in terms of subjective symptoms scoring and urodynamic finding, but no significant difference was found between the two groups. Late complications were also comparable. CONCLUSIONS: TmLRP-TT is an almost bloodless procedure with high efficacy and little perioperative morbidity. TmLRP-TT is superior to TURP in safety and is as efficacious as TURP in 1-yr follow-up. It is a promising technology in the clinical practice field.     

Bipolar versus monopolar transurethral resection of prostate: randomized controlled study

BACKGROUND AND PURPOSE: Transurethral resection of prostate (TURP) using bipolar electrocautery and physiologic saline is a new technical advancement in the field of surgical management of benign prostatic hyperplasia. The purpose of this study was to assess the efficacy and safety of this new technique and to compare the results with those of conventional monopolar TURP. PATIENTS AND METHODS: This study included 60 patients who were randomized 1:1 to bipolar (group 1) or monopolar (group 2) TURP. Bipolar TURP was performed with the Vista CTR resectoscope and generator (ACMI Corp.). Preoperatively, patients were assessed by symptom score, uroflow, and transrectal sonography, and the two groups were comparable with regard to these measures and age. The preoperative and postoperative parameters studied included resection time, amount of tissue resected, irrigant amount, blood loss, fluid absorption, and change in serum sodium and hemoglobin. Postoperatively, patients were assessed for symptoms, symptom score, and uroflow rate at 1 and 3 months. RESULTS: There was no difference in resected tissue amount, irrigant amount, fluid absorption, duration and amount of postoperative irrigation, or fall in hemoglobin. The mean resection rate was 0.61 g/min in group 1 and 0.74 g/min in group 2. Serum Na dropped by 4.6 Eq/L in group 2, whereas it fell only 1.2 mEq/L in group 1 (P < 0.001). Improvement in symptom and QoL scores and Q(max) were similar in the two groups. Postoperative dysuria was less common with bipolar resection. CONCLUSION: Bipolar resection of the prostate is as effective as monopolar TURP. Moreover, it does not lead to any change in serum Na and causes less postoperative dysuria.     

A randomized prospective study of laser ablation of the prostate versus transurethral resection of the prostate in men with benign prostatic hyperplasia

Objectives. To compare the safety and efficacy of laser ablation of the prostate, one of the minimally invasive treatments available for men with benign prostatic hyperplasia, to transurethral resection of the prostate (TURP).Methods. A prospective randomized study of 100 men with benign prostatic hyperplasia, with 50 patients in each treatment arm, was conducted. All patients met the entry criteria: age older than 45 years, no history of carcinoma of the prostate, a peak flow rate less than 15 mL/s, medical therapy failure, and the ability to undergo regional or general anesthesia. All patients underwent a preoperative evaluation consisting of the American Urological Association (AUA) symptom score, uroflowmetry, pressure-flow study, transrectal ultrasound for prostate volume, and serum prostate-specific antigen determination. Patients underwent either TURP or laser ablation of the prostate using the potassium titanyl phosphate (KTP)/neodymium:yttrium-aluminum-garnet laser. Patients were seen for follow-up at 1, 3, 6, and 12 months.Results. The mean age was 68.2 years (range 45 to 90) for the laser group and 67.4 years (range 54 to 82) for the TURP group. The mean AUA symptom score was 22 for the laser group and 21 for the TURP group. The mean peak uroflow rate was 7.6 ± 3.4 mL/s for the laser group and 6.5 ± 4.0 mL/s for the TURP group. At 12 months of follow-up, the mean AUA symptom score had decreased to 7 (−69.5%) for the laser group and to 3 (−80.9%) for the TURP group. The mean peak uroflow rate increased to 15.4 mL/s (+107.8%) for the laser group and to 16.7 mL/s (+150.7%) for the TURP cohort. Seventy-five percent of the laser group had a 50% or greater decrease in their individual AUA symptom score compared with 93% of the TURP group. Sixty-five percent of the laser cohort had a 50% or greater increase in their peak uroflow rate compared with 75% of the TURP cohort.Conclusions. Laser prostatectomy produced improvements in the peak flow rate and symptom score similar to those produced by TURP. The patients who underwent laser treatment required a longer period to reach maximum improvement, which probably reflects the lack of tissue debulking at the time of surgery. Further improvement in laser technology will be required to produce more immediate results.     

经尿道前列腺电切术与经尿道前列腺剜除加腹部小切口术治疗大体积前列腺增生的疗效比较

目的 探讨经尿道前列腺剜除加腹部小切口腺体取出来治疗大体积前列腺增生是否存在优势.方法 选取体积大于80ml前列腺增生患者160例,随机分成A、B两组,每组80例,A组行经尿道前列腺剜除加腹部小切口腺体取出术.B组行经尿道前列腺电切术.分别比较二组手术时间、出血量、并发症发生情况和术后排尿情况. 结果 A组与B组的手术时间分别为58±16 min、135±17min,出血量为89±23nl,189±21.5ml.A组无一例发生前列腺电切综合征(TURS);B组4例出现程度不等TURS,上述项目经统计学处理,两组差异有显著意义(P＜0.05).结论 经尿道腔内剜除加下腹小切口腺体取出术结合了微创及开放手术的优势,在不明显增加创伤情况下,缩短了手术时间,减少术中出血和腺体残留,是治疗大体积前列腺增生的实用方法,有较好的临床推广意义的.     

Plasmakinetic resection of the prostate versus standard transurethral resection of the prostate: a prospective randomized trial with 1-year follow-up

The aim of this study was to compare the clinical results of plasmakinetic resection of the prostate (PRP) with standard transurethral resection (TUR) of the prostate (TURP). A total of 240 patients (mean age 63.5; age range 52-90 years), with symptomatic benign prostatic hyperplasia were randomized into two groups and treated with two different techniques (TURP and PRP). We evaluated pre-operative, per-operative and post-operative (first and 12th months) findings of all patients. The mean catheterization time was 3 and 4.5 days in the PRP and standard TURP groups, respectively (P<0.001). We observed the improvements in maximum flow rates in PRP group were significantly higher than TURP group (P<0.001). TUR of the prostate using plasmakinetic energy seems to be a promising treatment alternative to conventional TURP. It has the advantages of low intraoperative and post-operative complications, short convalescence, excellent intraoperative hemostasis, absence of fluid absorption and TUR syndrome.     

A prospective randomized study comparing monopolar and bipolar transurethral resection of prostate using transurethral resection in saline (TURIS) system

OBJECTIVES: To compare transurethral resection of prostate (TURP) using monopolar and bipolar transurethral resection in saline (TURIS) system. MATERIALS AND METHODS: A prospectively randomized study was conducted between January 2004 and January 2005. Patient demographics and indications for surgery were recorded. The safety end points studied were occurrence of complications and decline in postoperative serum sodium (Na(+)) and hemoglobin (Hb) levels. Efficacy end points were resection time, weight of resected prostate tissue, and improvement in International Prostate Symptoms Score (IPSS) and maximum flow rate (Q(max)) in patients' uroflow over 12 mo. RESULTS: One hundred consecutive patients were randomized and completed the study, with 52 patients in the monopolar TURP group and 48 in the TURIS group. At baseline, the two groups were comparable; they had at least 12 mo of follow-up. Mean resection time and mean weight of resected prostate tissue were comparable for both groups. Declines in the mean postoperative serum Na(+) for TURIS and monopolar TURP groups were 3.2 and 10.7 mmol/l, respectively (p<0.01). However, there was no statistical difference in the decline in postoperative Hb between the two groups. There were two cases of clinically significant transurethral resection syndrome in the monopolar group. Urethral strictures were observed in three cases of TURIS and one patient in the monopolar group. The IPSS and Q(max) improvements were comparable between the two groups at 12 mo of follow-up. CONCLUSIONS: Bipolar TURP using the TURIS system is clinically comparable to monopolar TURP at 1 yr with an improved safety profile.     

Erectile and ejaculatory functions changes following bipolar versus monopolar transurethral resection of the prostate: a prospective randomized study

Objectives

To compare monopolar and bipolar transurethral resection of the prostate (M-TURP and B-TURP, respectively) focusing on erectile and ejaculatory functions in a randomized trial.

Methods

Between January 2013 and December 2014, all consecutive TURP candidates with benign prostatic hyperplasia (BPH) were prospectively randomized 1:1 into M-TURP/B-TURP arms and followed up at 2, and 4 weeks, 6 and 12 months after surgery. All patients were assessed using IIEF-15 (International index of erectile function-15) and Ej-MSHQ (ejaculatory domain-male sexual-health inventory). Changes in IIEF-15, its subdomains and Ej-MSHQ scores were compared between both intervention groups.

Results

Following M.TURP and B.TURP; 122 and 124 patients were included respectively and were considered for analysis at 1 year. Sexual function did not differ significantly between arms during follow-up (erectile function, P?=?0.82; orgasmic function, P?=?0.46; sexual desire, P?=?0.29; intercourse satisfaction, P?=?0.18; overall satisfaction, P?=?0.92). There were no differences between arms in the distribution of EF evolution at any time compared with base line (at 12 months: M-TURP vs. B-TURP?=?improved, 24.5 vs. 26.6%; stable, 66.4 vs. 64.5%; deteriorated, 9.1 vs. 8.9%; P?=?0.41). Newly developed erectile dysfunction (ED) was present in 8.2 and 7.3% of patients following M.TURP and B.TURP respectively and was related to presence of DM and obesity. Orgasm perception significantly reduced following M.TURP and B.TURP (P?<?0.001). Newly reported ejaculatory dysfunction (Ej-MSHQ?<?22) was significantly associated with low orgasm perception.

Conclusions

There were no differences between M-TURP/B-TURP in any aspect of sexual function.

     

Transurethral resection syndrome. A prospective study.

Significant hyponatraemia has been reported following transurethral prostatectomy (TURP) in 11-41% of cases. The majority of previous studies have been performed retrospectively. A prospective study was undertaken of 100 patients undergoing TURP. In all, a 24-Charr sheath with non-irrigating, resectoscope and 1.5% glycine as irrigant was used. Volume of irrigant used, weight of prostate and length of procedure were recorded. Serum electrolytes were measured at anaesthetic induction and immediately on transfer to the recovery room. In none of the 100 patients was there a statistically significant fall in serum sodium following resection. No clinical changes of transurethral resection (TUR) syndrome occurred. This study confirms that TUR syndrome and a significant fall in serum sodium can be virtually prevented in TURP and the use of an irrigating resectoscope or a trocar in the average case is not necessary.     

Transurethral prostatotomy versus transurethral prostatectomy in benign prostatic hypertrophy. A prospective randomised study

Transurethral prostatotomy (TUT) in 24 patients was compared with transurethral prostatectomy (TUR) in 25 patients in a prospective randomised trial. All patients were aged 60 years or more and presented with symptomatic benign hypertrophy. One half of the patients had acute retention. Shorter operative time and less post-operative bleeding were found in the TUT group, which included 3 failures. No difference was found in post-operative duration of catheterisation or duration of hospitalisation. No significant differences were seen after 1 year's follow-up in the number of patients with positive urinary culture or urinary flow rate. One patient in the TUT group had a recurrence of symptoms, thus giving a total of 4 failures and a success rate of 82%. One patient became incontinent after TUR and 4 developed a stricture. The success rate after TUR was 78%. It was concluded that TUT and TUR produce similar functional results in cases where the gland is not too large.