Outcome of the TURP-TUVP sandwich procedure for minimally invasive surgical treatment of benign prostatic hyperplasia with volume larger than 40cc over a 4-year period in Nigeria

IntroductionTransurethral resection of the prostate (TURP) remains the reference standard for the surgical treatment of infravesical obstruction due to benign prostatic hyperplasia (BPH). While TURP has proven long-term efficacy, it has some associated morbidities. This has fuelled the drive to develop alternative cost-effective options with comparable functional outcomes and a superior safety profile.ObjectivesThe aim of this study was to evaluate transurethral electro-vaporization of the prostate (TUVP) combined with TURP as a “sandwich” procedure in relieving the obstruction caused by BPH with volume of 40-80cc.Patients and MethodsThe medical notes of 57 consecutive patients with moderate to severe bladder outflow symptoms due to BPH who underwent TURP-TUVP as a sandwich procedure from April 2007 to March 2011 were reviewed for prostatic volume, duration of surgery, volume of irrigation fluid used intra-operatively and post-operative hospital stay. Similarly, the patients IPSS, Qmax and PVR were evaluated pre- and postoperatively.ResultsThe mean patient age was 64.1 years (SD = 9.1), mean prostatic volume was 56.8 cc (SD = 8.9), mean resection time was 69.5 minutes (SD = 23.9) and mean volume of irrigation fluid (1.5% Glycine) used was 21.5 L (SD = 4.9).The mean post-operative hospital stay was 3.5 days (range 3- 4 days). Overall, 11 (19%) patients had blood transfusion, there was no incidence of TUR syndrome and one mortality was recorded from primary plasminolysis. Compared with baseline values, on follow-up at 3 months the IPSS, Qmax and PVR had improved significantly. Bladder neck stenosis occurred in 3 patients and was successfully treated with bladder neck incision.ConclusionsThe sandwich combination of TURP and TUVP for the surgical treatment of BPH with volume larger than 40cc had satisfactory patient safety profile and resulted in significant improvement in IPSS, Qmax and PVR on follow-up at 3 months.