The early postoperative morbidity of transurethral resection of the prostate and of 4 minimally invasive treatment alternatives.

PURPOSE: We compared the early postoperative morbidity of transurethral resection of the prostate to minimally invasive treatment alternatives with respect to the objective rate of complications and subjective morbidity assessed by a patient addressed diary-type questionnaire.
MATERIALS AND METHODS: Parameters evaluated preoperatively were the International Prostate Symptom Score (I-PSS), free flow study, post-void residual, transrectal ultrasonography and a pressure-flow study. The patients underwent transurethral resection (28), transrectal high intensity focused ultrasound (20), visual laser ablation (15), transurethral needle ablation (15) and transurethral electrosurgical vaporization (17) of the prostate. On the day of hospital discharge the patients received the questionnaire and were asked to answer daily 7 questions concerning micturition status. After 6 weeks the questionnaire was returned and an I-PSS, uroflowmetry and post-void residual were obtained.
RESULTS: Preoperatively, there was no statistically significant difference regarding the I-PSS, peak flow rate, prostate volume and degree of bladder outlet obstruction. After 6 weeks the peak flow rate improved most prominently after transurethral electrosurgical vaporization (+ 13.2 ml. per second), transurethral resection of the prostate (+ 12.3 ml. per second) and visual laser ablation (+ 11.1 ml. per second). The I-PSS decreased most significantly after transurethral resection (-14.1) and transurethral electrosurgical vaporization (-8.4). There was no difference regarding the rate of adverse events within the first 6 weeks postoperatively in the 5 treatment arms. Mean duration of catheter drainage plus or minus standard deviation was 3.7 +/- 1.2 days after transurethral resection of the prostate, 6.8 +/- 1.7 days after high intensity focused ultrasound, 7.8 +/- 1.5 days after visual laser ablation, 2.0 +/- 0.4 days after transurethral needle ablation and 3.3 +/- 0.8 days after transurethral electrosurgical vaporization. Analysis of the questionnaire revealed that the daytime frequency, degree of hematuria and incontinence were comparable for all 5 procedures within the first 6 weeks postoperatively. Postoperative dysuria was greatest after visual laser ablation and transurethral electrosurgical vaporization. Regarding the degree of nocturia, there was no improvement after visual laser ablation, while the remaining 4 procedures yielded a significant and comparable decrease. The most significant subjective improvement in uroflowmetry was reported after transurethral resection of the prostate and transurethral electrosurgical vaporization. Regarding the global quality of life question, the patients were generally more worried after visual laser ablation and transurethral needle ablation compared to the other 3 procedures.
CONCLUSIONS: The overall morbidity of transurethral resection of the prostate within the first 6 weeks postoperatively is equivalent to that of the 4 minimally invasive treatment alternatives evaluated in our study. When comparing the 4 minimally invasive procedures, no dramatic differences were notable, although visual laser ablation seems to be associated with a greater degree of morbidity as assessed by this questionnaire.