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Objective: The aim of this study was to determine the efficacy of short-duration use of finasteride and dutasteride before transurethral resection of the prostate (TURP) on intraoperative blood loss and microvessel density (MVD) of prostate stroma and suburethral tissues in benign prostatic hyperplasia (BPH)., Methods: This study includes 450 patients who were planned for TURP. They were prospectively randomized into three groups (150 patients each). Group 1 received placebo, group 2 received finasteride, 5 mg per day, and group 3 patients received dutasteride, 0.5 mg per day, for 4 weeks before surgery. The total blood loss, requirement of blood, and MVDs in prostate stroma and suburethral tissues were calculated in each patient and then compared among three groups., Results: There was significant reduction in mean blood loss, blood loss/time, and total blood loss per gram of resected tissue in finasteride and dutasteride groups compared with placebo. Prostate stromal and suburethral MVDs were significantly higher compared with placebo. Blood transfusion was required in 9.3%, 2.7%, and 2% of the patients, respectively (p = 0.004). However, no statistically significant differences were observed between finasteride and dutasteride groups for these parameters (p > 0.05). The weight of resected prostate, operating time, and amount of irrigation fluid used did not show any significant difference between the three groups., Conclusion: Short-term pretreatment with finasteride and dutasteride has similar efficacy and significantly reduces perioperative bleeding during TURP and has minimal negative impact on sexual function. According to our findings, a 4-week prior administration of 5-alpha-reductase inhibitors may reduce operative blood loss and prostatic MVD in TURP, thus potentially decreasing blood loss-related complications and the requirement of blood transfusion.

Objective: To compare the efficacy and results of bladder neck incision (BNI) in bladder outlet obstruction (BOO) in men with a small prostate using holmium laser vs conventional monopolar electrocautery technique., Materials and Methods: This study included 140 patients of BOO (prostate size ≤ 30 cc, American Urological Association (AUA) score ≥ 8, Qmax ≤ 15 mL/sec, and Schäfer grade ≥ 2) who were randomly assigned to holmium laser BNI (HoBNI) or conventional BNI (C-BNI). AUA score and Qmax were assessed preoperatively and postoperatively at 3, 6, and 12 months. At 6 months, detrusor pressure at Qmax, Schäfer grade, and postvoid residual were assessed., Results: The incidence of postoperative hematuria and blood transfusion in the C-BNI group were 4.2% and 2.8%, respectively. No patient in the HoBNI group developed hematuria or required blood transfusion. Qmax and AUA score at each follow-up, and Pdet Qmax, Schäfer grade, and postvoid residual at 6 months were comparable between two groups but showed significant improvement when compared to baseline in both the groups. At 6 months, 2.9% patients in the HoBNI group and 4.3% in the C-BNI group remained obstructed urodynamically and underwent reoperation (P > .05). The incidence of retrograde ejaculation was significantly higher in HoBNI (22.9% vs 6.1%, P -.02) CONCLUSION: Both procedures are equally efficient in relieving BOO in patients with prostate size < 30 cc and have similar success rates. The risk of postoperative hematuria is less with HoBNI because of its better hemostatic properties, but its use must be counterbalanced with significant increase in incidence of retrograde ejaculation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: Photovaporization of prostate (PVP) is a newer surgical modality of benign prostatic hyperplasia (BPH) which is gaining importance recently. There are a few randomized controlled trials that showed safety and efficacy of PVP in comparison with transurethral resection of prostate (TURP) with limited follow- up period (<2 years). Here, we are presenting a comparative study performed on potassium titanyl phosphate (KTP) PVP laser versus TURP for the treatment of BPH with long- term follow-up period. Material and methods: After institutional ethical clearance, 150 patients were prospectively included in the study from January 2010 to March, 2012. Improvement of International Prostate Symptoms Score (IPSS), Qmax, post- void residual (PVR) urine, International Index of Erectile Function (IIEF)-5 score and complications were assessed at 12, 24, 36 and 48 months. Results: Mean age of the study group was 65.3±7.86 years in the TURP and 63.6±8.12 years in the PVP groups (p=0.45). IPSS symptom score improved significantly in both TURP and KTP groups (p<0.003). There was improvement in Q max during follow- up in both groups (p<0.001) which was maintained at 48 months. Most of the patients in both groups were satisfied with symptoms and bothersome at 48 months. All the sexual parameters are similar to both groups except retrograde ejaculation. Overall complication noted in 23 patients (15.33%). Conclusion: Both KTP Laser PVP and TURP afford durable relief from symptoms of BPH at 48 months follow- up. Both procedures are safe and associated with minimal complications. Both procedures do not have any detrimental effect on sexual function on long- term follow- up. Quality of life remains high even at 4 years in both groups. [ABSTRACT FROM AUTHOR]

Aim: Transurethral resection of prostate (TURP) is considered a gold standard surgical procedure. The management of benign prostatic hyperplasia (BPH) has undergone tremendous change in recent years and shifted from open to minimal invasive procedure. With the advancement in technology and skills of surgeons, lasers have been used more liberally, particularly holmium laser. Holmium laser enucleation of prostate (HoLEP) is seen as close rival of TURP. The objective if this study is to observe long- and short-term outcomes of transurethral resection and holmium laser enucleation in the prostate of more than 60 g. Materials and Methods: This prospective randomized study includes 164 patients. Inclusion criteria were age <75 years after failed or poor response to medical therapy, prostatic size >60 g, gross hematuria secondary to BPH, recurrent urinary tract infection, acute urinary retention, postvoid residual >150 ml, and Schafer Grade II or more. BPH associated with neurogenic bladder, stricture urethra, and carcinoma prostate were excluded from the study. Group 1 comprises patients who underwent TURP and Group 2 comprises who underwent HoLEP. Follow-up was done at 1, 3, 6, 12, and 24 months after the surgery. Results: Data of 144 patients were analyzed. The mean age of patients in TURP and HoLEP group was 66.78 ± 7.81 and 67.70 ± 7.44 years, respectively (P = 0.47), mean prostatic volume was 74.5 ± 12.56 and 75.6 ± 12.84 g, respectively (P = 0.60), operative time was 73.10 ± 10.49 and 89.56 ± 13.81 min, respectively (P = 0.0001). Mean resected tissue was 44.80 ± 9.87 and 48.49 ± 10.87, respectively (P = 0.03). The sexual function did not changed significantly in postoperative follow-up. Conclusion: HoLEP is associated with less blood loss, lower transfusion rates, and a shorter hospital stay. The disadvantage of HoLEP is longer operative time and postoperative dysuria. [ABSTRACT FROM AUTHOR]