Comparative Study of Turp versus Medical Management in Benign Prostatic Hyperplasia

Abstract

Objective: To identify the differences in the efficacy, safety and quality of life after transurethral resection of the prostate (TURP) and medical management in Pakistani men with moderate to severe benign prostatic hyperplasia (BPH).

Materials and Methods: A prospective randomized controlled trial was used as the study design in three tertiary care centres in Pakistan during the period between January 2023 and December 2024. Two hundred and forty men of [?]50 years with moderate to severe LUTS (IPSS 8-19) and a 30-80 mL prostate volume were randomly matched into TURP (n=120) versus medical treatment using tamsulosin 0.4 mg daily +- finasteride 5 mg daily (n=120). The primary outcomes were change in IPSS score, maximum urinary flow rate (Qmax), and quality of life (QoL) index in 6 months. Secondary outcomes were complication rates, the incidence of acute renal failure and re-intervention.

Results: Findings at 6 months TURP showed much higher increase in IPSS (14.2+-3.1 vs 6.8+-2.9), Qmax (+9.8+-3.2 vs +3.1+-1.8 mL/s) and QoL index ([?]3.4+-1.1 vs +1.9+-0.9) over medical treatment. The AUR rate was much less in the TURP-group (2.5% vs 15.8% p=0.001). Fewer immediate complications were noted in medical management (4.2% vs 18.3% p=0.002) although the majority of TURP complications were minor and self-limiting. Re-intervention of TURP was needed in 3.3 percent of the patients compared with 22.5 percent in the medical patients (p<0.001).

Conclusion: TURP is more effective rather than medical management in symptomatic relief, urodynamic and disease progression in Pakistani patients who have moderate to severe BPH. Although initial complication rates are greater, TURP is more effective in the long term and has reduced re-intervention rates, and hence is economical in a resource-restrained environment where late presentation with complications is prevalent.