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.