Current status of transurethral prostatectomy: a korean multicenter study.
ABSTRACT We aimed to verify the current status of transurethral resection of the prostate (TURP) in Korea.
The medical records of 1,341 men who underwent TURP in 9 Korean medical centers between 2004 and 2008 were reviewed. The patients were divided into two groups according to time periods: 2004-2005 (group 1) and 2006-2008 (group 2). To verify differences in the two patient groups, age, prostate volume, indications for TURP, preoperative International Prostate Symptom Score (IPSS), and resected tissue weight were evaluated.
The mean age of the patients was 71.2 years and the mean IPSS was 22.7. The patients' characteristics were not significantly different between the two groups. The annual cases of TURP increased over the study period. The proportion of lower urinary tract symptoms (LUTS) as an indication for TURP increased up to 58.3% in group 2 compared with 51.6% in group 1 (p=0.019). However, the proportion of patients who presented with acute urinary retention decreased from 35.5% to 30.3% with marginal statistical significance (p=0.051). Other indications such as hematuria, bladder stone, recurrent urinary tract infection, and hydronephrosis were not significantly different between the groups. The mean resected weights of the prostate were similar (17.5 g in group 1 and 18.3 g in group 2, respectively; p>0.05).
TURP has been steadily performed in patients with benign prostatic hyperplasia and it is expected to remain constant. LUTS was the most common indication for TURP in recent years.
- The Journal of Urology 03/2002; 167(2 Pt 2):999-1003; discussion 1004. · 3.70 Impact Factor
- BJU International 03/1999; 83(3):227-37. · 3.05 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: To assess health care use and costs for benign prostatic hyperplasia (BPH) in Sweden from 1987 to 1994 when minimal invasive procedures, including transurethral microwave therapy (TUMT) and drugs, were introduced, in addition to conventional surgery. Cross-sectional annual data on health care utilization based on national information systems and surveys were used for calculation of direct 1994 cost. The total number of men in the age group at risk for BPH was virtually constant, and the total direct health care costs for BPH treatment increased from 1987 to 1992. A slight decrease was evident for the years 1993 and 1994, notwithstanding the introduction of new ambulatory procedures in 1991 and of new drugs in 1992. The number of physician office visits changed little during the study period, although this estimate may be low. TUMT procedures were introduced rapidly but decreased; nevertheless, their share was never more than 3% of total costs. Drug sales were 15-fold those in 1992 and accounted for 12% of the total costs in 1994. Conventional transurethral resection of the prostate (TURP) operations decreased markedly after the introduction of the new treatments. The new treatments were adopted differently. TUMT procedures decreased as rapidly as they were introduced. Three years after the introduction of the new drugs, drug sales indicated that the number of men receiving drug treatment was greater than the annual number of men receiving TURP operations and TUMT procedures combined. Yet the total costs showed a slight decrease, mainly due to the decreasing numbers of TURP operations.Urology 09/1997; 50(2):214-9; discussion 219-20. · 2.42 Impact Factor
Korean Journal of Urology
Ⓒ The Korean Urological Association, 2011
Korean J Urol 2011;52:406-409
Current Status of Transurethral Prostatectomy: A Korean
Dong Gyu Jang, Changhee Yoo, Cheol Young Oh, Se Joong Kim1, Sun Il Kim1, Chun Il Kim2,
Hong Sup Kim3, Jong Yeon Park4, Do Hwan Seong5, Yun Seob Song6, Won Jae Yang6, In Rae Cho7,
Sung Yong Cho7, Sang Hyeon Cheon4, Hyoungjune Im8, Jin Seon Cho
Department of Urology, College of Medicine, Hallym University, Chuncheon, 1Ajou University, Suwon, 2Keimyong University, Daegu,
3Konkuk University, Chungju, 4Ulsan University, Ulsan, 5Inha University, Incheon, 6Soonchunhyang University, Seoul, 7Inje University,
Gimhae, 8Department of Occupational and Environmental Medicine, College of Medicine, Hallym University, Chuncheon, Korea
Purpose: We aimed to verify the current status of transurethral resection of the prostate
(TURP) in Korea.
Materials and Methods: The medical records of 1,341 men who underwent TURP in
9 Korean medical centers between 2004 and 2008 were reviewed. The patients were
divided into two groups according to time periods: 2004-2005 (group 1) and 2006-2008
(group 2). To verify differences in the two patient groups, age, prostate volume, in-
dications for TURP, preoperative International Prostate Symptom Score (IPSS), and
resected tissue weight were evaluated.
Results: The mean age of the patients was 71.2 years and the mean IPSS was 22.7. The
patients’ characteristics were not significantly different between the two groups. The
annual cases of TURP increased over the study period. The proportion of lower urinary
tract symptoms (LUTS) as an indication for TURP increased up to 58.3% in group 2
compared with 51.6% in group 1 (p=0.019). However, the proportion of patients who
presented with acute urinary retention decreased from 35.5% to 30.3% with marginal
statistical significance (p=0.051). Other indications such as hematuria, bladder stone,
recurrent urinary tract infection, and hydronephrosis were not significantly different
between the groups. The mean resected weights of the prostate were similar (17.5 g
in group 1 and 18.3 g in group 2, respectively; p＞0.05).
Conclusions: TURP has been steadily performed in patients with benign prostatic hy-
perplasia and it is expected to remain constant. LUTS was the most common indication
for TURP in recent years.
Key Words: Prostatic hyperplasia; Transurethral resection of prostate
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial
License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use,
distribution, and reproduction in any medium, provided the original work is properly cited.
received 22 March, 2011
accepted 23 May, 2011
Jin Seon Cho
Department of Urology, Hallym
University Sacred Heart Hospital, 896,
Anyang 431-070, Korea
For many decades, transurethral resection of the prostate
(TURP) has been considered the gold standard surgical
treatment for lower urinary tract symptoms (LUTS), acute
urinary retention (AUR), recurrent infection, hematuria,
and azotemia resulting from benign prostatic hyperplasia
(BPH) . Despite the efficacy and safety of pharmacother-
apy, the surgical management of BPH is still recommended
in certain conditions, including the presence of refractory
urinary retention, bladder stone, persistent gross hema-
turia, recurrent urinary tract infection, or renal insuffi-
ciency secondary to BPH .
Although TURP remains an effective treatment, 15% to
20% of patients develop significant complications, and 10%
to 15% require a second intervention within 10 years .
To improve safety outcomes, a number of minimally inva-
sive surgical techniques have been developed for the treat-
Korean J Urol 2011;52:406-409
Current Status of Transurethral Prostatectomy
FIG. 1. Annual cases of transurethral resection of prostate in 9
medical centers Linear regression showed No.=40.8 x year−b.
TABLE 1. Characteristics of the patients who underwent TURP
CharacteristicsGroup 1Group 2Totalp-value
No. of TURP
Resected weight 17.5±13.4
Data presented with standard deviation. IPSS: International Pro-
state Symptom Score, PSA: prostate-specific antigen, TPV: total
prostate volume, TURP: transurethral resection of prostate
TABLE 2. Indications for TURP in the time periods analyzed
222 (52.9) 540 (58.8) 762 (57.0)
Lower urinary tract
Mild to moderate
46 (25.6) 154 (35.6) 200 (32.6) 0.016a
134 (74.4) 279 (64.4) 413 (67.4)
153 (36.4) 289 (31.5) 442 (33.0) 0.051
79 (5.9) ＞0.05
30 (2.2) ＞0.05
2 (0.1) ＞0.05
4 (0.3) ＞0.05
19 (1.4) ＞0.05
TURP: transurethral resection of prostate, IPSS: International
Prostate Symptom Score, a: chi-square statistical analysis be-
tween the mild to moderate symptom group and the severe symp-
ment of LUTS related to BPH, such as needle ablation, elec-
trovaporization, vaporization resection, holmium laser, ul-
trasound, and microwave therapy . Moreover, the intro-
duction of medical therapy has brought about significant
changes in the management of patients with moderate to
severe LUTS . In the era of medical therapy, TURP
seems to be performed less frequently in patients with
symptomatic BPH. The objective of this study was to assess
the current status of TURP for BPH in Korea.
MATERIALS AND METHODS
The medical records of 1,341 men who underwent TURP
in 9 medical centers between 2004 and 2008 were reviewed.
Patients were eligible for inclusion only if their primary
reason for TURP was BPH. Patients undergoing open pros-
tatectomy were not included in this surgical analysis.
Patients were excluded if they underwent TURP for carci-
noma of the prostate or if their postoperative pathology was
not compatible with a BPH diagnosis. The patients were
divided into two groups according to the time periods in
which they underwent TURP: 2004-2005 (group 1) and
2006-2008 (group 2). To verify the differences in the two pa-
tient groups, the parameters of age, prostate volume, in-
dications for TURP, preoperative International Prostate
Symptom Score (IPSS), and resected tissue weight were
evaluated. The symptom severity of the patients was div-
ided into two categories by IPSS as mild to moderate (IPSS
＜20) and severe (IPSS≥20). Preoperative prostatic vol-
ume was measured by transrectal ultrasound. The weight
of the resected chips was documented from the pathology
Statistical analysis was performed by using the Student’s
t-test and chi-square test for categorical variables and a lin-
ear regression analysis for continuous variables. Results
were considered significant at p＜0.05.
A total of 1,341 patients were identified with an average
age of 71.2 years (range, 41-94 years). The average IPSS
was 22.7. The baseline characteristics of the patients in-
cluding IPSS, prostate volume, and serum prostate-specif-
ic antigen (PSA) were similar between the groups. The
mean age of group 1 was 71.9 years, which was older than
that of group 2 (Table 1).
The annual cases of TURP increased over the study peri-
od (Fig. 1). The proportion of LUTS as an indication for
TURP increased up to 58.3% in group 2 compared with
51.6% in group 1 (p=0.041). Also, the proportion of patients
who underwent TURP for severe LUTS significantly de-
creased from 74.4% in group 1 to 64.4% in group 2, respec-
tively (p=0.016). However, the proportion of patients who
presented with AUR decreased from 35.5% to 30.3% with
marginal statistical significance (p=0.051). The number of
patients who suffered from hematuria, bladder stone, re-
current urinary tract infection, and hydronephrosis before
their TURP was not significantly different between the
time periods (Table 2).
Korean J Urol 2011;52:406-409
Jang et al
The average weight of the resected prostate was 18.0 g
(range, 1.5-90 g). Over the study period, similar mean wei-
ghts of the prostate were resected (17.5 g in group 1 and 18.3
g in group 2; p＞0.05).
Two decades ago, we did not frequently offer medical ther-
apy to patients with symptomatic LUTS associated with
BPH, but rather recommended TURP as the primary mode
of treatment. Over the course of the past two decades, medi-
cal therapy has become the standard first-line therapy for
symptomatic LUTS associated with BPH. The increasing
use of other minimally invasive treatment modalities, such
as ablation, evaporation, and enucleation technique with
laser, has led to a decline in TURP [6,7]. An American study
reported a 43% decrease in cases of TURP between 1987
and 1994 , and this decline has also been observed in
Europe . Enthusiastic reports on the success of alter-
native treatment options represented by ‘minimally in-
vasive treatment’ in the urological press seemed to herald
the end of TURP as the gold standard, perhaps best re-
flected by Stamey’s quote that ‘TURP is now a therapy of
history’ . In our study, however, contrary to other re-
ports, the annul number of TURP procedures for BPH in-
creased during the mid 2000s, despite other treatment mo-
dalities for BPH. One possible explanation for this increas-
ing annual number of TURP procedures during the mid
2000s is the high prevalence of BPH in aged men and the
continuously growing number of elderly men with BPH
who needed surgical treatment. The other explanation is
that the urologists participating in this study, to whom
minimally invasive modalities were not available, per-
formed TURP enthusiastically. Considering these facts,
the overall proportion of TURP might be decreasing.
The proportion of TURP owing to BPH-related sympto-
matic LUTS in the current study increased over the time
period. Several series of studies have demonstrated that
medical treatment for patients with symptomatic BPH
with an α-adrenergic antagonist and 5-α reductase in-
hibitors could lower the risk of AUR and recurrent gross
hematuria [8-10]. It was our hypothesis that a trial of medi-
cal therapy that ended in failure may increase this propor-
tion. In several previous studies, similar observations were
reported. In 1990, 2% of patients undergoing TURP had
previously been on prostatic medical therapy, and this pro-
portion was increased up to 17% in 2000 . In 57.0% of
our patients, TURP was performed because of significant
LUTS, which was the most common indication. Borboroglu
et al reported that 80.9% of patients had significant LUTS
preoperatively . However, a controversial result was
reported that TURP was performed in only 29.5% of pa-
tients with symptoms of prostatism . These differences
might be due to many factors, including public awareness
about the disease, accessibility to medical care, widespread
use of pharmacological agents as alternative therapy, and
the health care system of each country. Although the exact
number of patients taking pharmacological agents before
TURP was not evaluated in our study, the majority might
receive some form of medication for BPH before TURP.
There was a trend for the proportion of patients under-
going TURP because of AUR to decrease over the time peri-
od in the current study. We can attribute this observation
to reduced needs for surgery by a voiding trial without cath-
eter and medical treatment. However, in England, over a
10-year study between 1990 and 2000, the proportion of pa-
tients who underwent TURP for urinary retention in-
creased from 33% to 58%, which has become the most com-
mon indication of TURP, whereas LUTS as an indication
of TURP decreased from 65% to 42% . Preoperatively,
33.0% of patients presented with AUR, which is still a
somewhat higher rate than those reported in previous
studies (15.2% to 27.1%) [3,12]. McConnell et al and
Roehrborn et al demonstrated a lower rate of AUR in pa-
tients given medical therapy (α-adrenergic antagonist
and/or 5-α reductase inhibitors) than in those given place-
bo [8,13,14]. This could be another explanation for the ten-
dency for the proportion of patients who underwent TURP
for AUR to decrease in our study.
The low incidence of recurrent gross hematuria as an in-
dication for TURP (5.9%) compared to the study of Mebust
et al (12.0%) in the era of no acceptable medical therapy for
BPH could be due to the widespread use of medical therapy
. Finasteride has been shown to be effective for the treat-
ment of BPH-related recurrent gross hematuria in more
than 90% of treated patients [12,15].
The incidence of obstructive uropathy, as evidenced by
the presence of hydronephrosis, was only 0.3% in our study.
BPH-related renal insufficiency as an indication for TURP
was under 1% in most studies [12,15]. This low incidence
of obstructive uropathy could result from early access to
medical care nowadays.
Because of the increasing use of pharmacological ther-
apy in the management of BPH-related LUTS, TURP
would be deferred. Also, delay in surgical therapy results
in the progression of BPH.
Patients treated by TURP show an increase in not only
prostate volume but also resected prostate volume, which
may be because the surgery was delayed by treatment with
α-1 blockers or 5-α reductase inhibitors .
As a result, it is supposed that larger glands would be re-
sected in the era of medical therapy for BPH. The average
weight of the resected prostate tissue in this study was 18.0
g, which was comparable to that in other reports (18.8-37
g) [3,12,17,18]. However, the resected prostate volume was
not significantly different between the groups in the pres-
The mean age of the patients in group 1 was older than
in group 2. This means that we consider TURP as a pre-
emptive treatment in the era of medical therapy for BPH.
Meanwhile, among patients with LUTS (IPSS≥20) as
an indication for TURP, severe LUTS decreased from 74.4%
in group 1 to 64.4% in group 2. This might be explained by
the operators’ active trial or patients’ increased request for
Korean J Urol 2011;52:406-409
Current Status of Transurethral Prostatectomy
TURP during this period.
This multicenter study of 5-years’ experience with TURP
is obviously limited by the retrospective nature and the
short time period in which changes in the indication for
TURP were evaluated. Moreover, because the 9 institutions
involved in this study do not represent Korean urological
society, the incidence of TURP may not be generalizable.
Also, the effect of the minimally invasive procedures and
medical therapy for BPH was not considered in this study.
Because the prevalence of BPH is increasing in the Korean
population, the proportion of TURP among the treatment
options for BPH might have decreased relatively. However,
we could see a temporal treatment status of TURP.
In the mid-2000s, TURP was steadily performed in pa-
tients with BPH and it is expected to remain constant. The
proportion of TURP as a treatment for symptomatic BPH-
related LUTS has increased. These changes seemed to co-
incide with the increasing use of medical therapy as a first-
line treatment for LUTS associated with BPH. TURP is
still considered as an effective surgical intervention for
BPH and as such is expected to be constantly performed
even in the era of medical therapy and minimally invasive
therapy for BPH.
Conflicts of Interest
The authors have nothing to disclose.
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