title: Transurethral vapor resection of prostate is a good alternative for prostates >70 g.
abstract: OBJECTIVE
  The morbidity associated with transurethral resection of the prostate (TURP) for large-volume prostates has prompted attempts to modify the standard equipment and techniques. Patients with large prostates (>70 g) need longer operative time, and have greater blood loss and higher irrigant fluid requirements; therefore, the traditional surgical recommendation for the management of benign prostatic hyperplasia (BPH) >70 g is open surgery. We assessed the effectiveness and safety of transurethral vapor resection of the prostate (TUVRP) for the management of prostate glands with a volume >70 g.
  
  
  METHODS
  Eighty-nine patients with a diagnosis of BPH who had a prostate volume >70 grams determined by abdominal ultrasonography underwent TUVRP between July 2002 and March 2006. Preoperative evaluation included assessment of International Prostate Symptom Score (IPSS), prostate volume, postvoid residual (PVR), and maximum flow rate (Q(max)). Intraoperative and postoperative parameters, including operative time, total irrigant requirement, blood loss, duration of postoperative catheterization, hospital stay, and complications were also analyzed.
  
  
  RESULTS
  The mean prostate volume for the 89 patients was 83.3 g (range 70-169 g). The mean age was 67.25 years (range 55-87 yr). Symptom duration varied from 2 months to 7 years. Twenty-two patients used a catheter preoperatively. The mean IPSS score, Q(max), and PVR were 23, 7.1 mL/sec, and 116 mL, respectively. The mean operative time was 64 minutes, and mean irrigant used was 21.4 L. The mean weight of resected tissue was 31.3 g. The average postoperative catheter duration was 2.25 days. Complications included transient dysuria in 11 patients, hyponatremia in two patients, and urethral stricture in two patients. No patient required a blood transfusion postoperatively. The effectiveness as assessed at 6 months was IPSS 5.1, Q(max) 22.5 mL/sec, and PVR not significant.
  
  
  CONCLUSIONS
  TUVRP is safe and effective in patients with large prostates (>70 g) with minimal complications and faster postoperative recovery. This technique helps to avoid the morbidity associated with open surgery.
authors.affiliation: Department of Urology, All India Institute of Medical Sciences, New Delhi, India. narmadagupta@hotmail.com
authors.forename: Narmada P
authors.initials: NP
authors.lastname: Gupta
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Singh
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D014835:Volatilization