Middle-Lobe-only TURP Offers Relief in Benign Prostatic Hyperplasia

By Reuters Staff

October 31, 2019

NEW YORK (Reuters Health) - Middle-lobe-only transurethral resection of prostate (MLO-TURP) relieves symptoms associated with benign prostatic hyperplasia (BPH) without causing ejaculatory dysfunction, researchers report.

TURP is commonly used to manage symptoms of bladder outlet obstruction associated with BPH, but adverse sexual events (primarily ejaculatory dysfunction) follow TURP in up to 75% of men.

Dr. Steven Kaplan from Icahn School of Medicine at Mount Sinai in New York City and colleagues report their 12-year experience with MLO-TURP in 312 consecutive men who presented with significant lower urinary tract symptoms (LUTS) or urinary retention resulting from BPH.

At one-year follow-up, there were significant improvements in International Prostate Symptom Score (IPSS), peak flow rate (Qmax), postvoid residual urine (PVR), and quality of life. These improvements persisted throughout the 12-year follow-up period.

At baseline, 82% of men were sexually active; 78% remained sexually active at five years, with no significant deterioration of Male Sexual Health Questionnaire ejaculatory dysfunction scores and modest improvement in bother due to ejaculatory function.

During follow-up, seven patients (2.2%) required a second TURP, all for recurrent and bothersome symptoms, the researchers report in Urology, online September 26.

At five years, 5.5% of patients were on an alpha blocker, 11% were on a 5-alpha reductase inhibitor, and 2.3% were on an antimuscarinic medication.

"In select men with prominent middle lobe hypertrophy, MLO-TURP should be considered as a therapeutic, ejaculation-sparing option," the authors conclude. "The generalizability of our results is limited to patients with obstruction secondary to significant intravesical enlargement and protrusion."

Dr. Kaplan did not respond to a request for comments.

SOURCE: https://bit.ly/2MkRslv

Urology 2019.