INCISION CERVICO-PROSTATIQUE: EVALUATION OBJECTIVE ET SUBJECTIVE DE L'EFFICACITE A LONG TERME

The emergence of less invasive therapies has demanded the reassessment of surgical procedures for the treatment of benign prostatic hyperplasia. This study was designed to evaluate the long term efficacy of transurethral incision of the prostate (TUIP) using objective (urodynamic), and subjective (symptom score and assessment of satisfaction) parameters, and investigate sexual function. Forty one men after TUIP (mean age of 63.4 years) were reviewed, with a mean follow up of 53 months (range 12-96). Preoperative symptom score (based on Madsen-Iversen score) and urodynamic evaluation were compared to recent post TUIP symptom score, urodynamic evaluation, and satisfaction interview. Total symptom score, as well as obstructive and irritative components, significantly decreased after TUIP (p < 0.0001). Mean detrusor pressure at peak flow decreased from 85 to 44 cm H₂O (p < 0.0001), and mean maximal detrusor pressure decreased from 114 to 55 cm H₂O (p < 0.0001). Mean peak uroflow rates increased from 10.3 to 15.3 cc/sec (p = 0.019). Thirty two of the men (82%) reported long term improvement after TUIP, with an overall satisfaction rate of 67% (range 0-100). Regardless of objective urodynamic criteria (indicating obstruction or relief of obstruction), the number of men reporting subjective improvement, and the degree of improvement, were similar. Only 4 men (11%) reported new retrograde ejaculation. The proportion of men improved after TUIP compares favorably to long term data available on TURP. Assessing the degree of improvement (overall satisfaction) is unique and has not been previously reported. These results clearly demonstrate that, in selected patients, TUIP is an effective procedure for long term relief of outlet obstruction.