Rotoresection Versus Transurethral Resection of the Prostate: Short-Term Evaluation of a Prospective Randomized Study

Purpose

We compared in a prospective fashion the short-term outcome of rotoresection to transurethral resection of the prostate.

Materials and Methods

A total of 50 patients with bladder outlet obstruction secondary to benign prostatic hyperplasia were randomized into 2 groups, rotoresection and transurethral resection of the prostate. Mean ± SD patient age was 60.76 ± 5.85 years in the rotoresection and 64.24 ± 6.84 in the transurethral resection groups. All patients had an International Prostate Symptom Score of 8 or more, maximum free flow rate less than 15 ml per second, prostate volume 20 to 100 ml and prostate specific antigen 1 to 4 ng/ml. Pressure flow study revealed bladder outlet obstruction (Schafer’s grade 3 or more). Patients were assessed at 1, 3 and 6 months by International Prostate Symptom Score, maximum free flow rate, transrectal ultrasound, pressure flow study, hemoglobin and urinalysis.

Results

At 6 months International Prostate Symptom Score decreased from 26.2 ± 4.06 to 5.32 ± 1.52 in the rotoresection group and from 22.84 ± 4.56 to 7 ± 1.4 in the transurethral resection group. Maximum free flow rate increased from 7.87 ± 2.24 to 25.29 ± 10.39 ml per second in the rotoresection group and from 9.44 ± 2.29 to 25.2 ± 5.8 ml per second in the transurethral group. Prostate volume decreased from 41.2 ± 16.58 to 17.24 ± 7.61 ml in the rotoresection group and from 40.6 ± 16.93 to 18.28 ± 8.75 ml in the transurethral group. Detrusor pressure at maximum flow and Schafer grade decreased from 79.84 ± 26.8 cm H₂O and 4.24 ± 0.97 to 38.8 ± 18.8 cm H₂O and 1.24 ± 0.93 in the rotoresection group, and from 63.04 ± 21.08 cm H₂O and 3.48 ± 0.65 to 34.16 ± 12.7 cm H₂O and 1 ± 0.7 in the transurethral group. Dilutional hyponatremia was higher with transurethral resection of the prostate (p = 0.005) but no patient showed manifestations of the transurethral syndrome. Mild stress urinary incontinence was noted in 4 patients in the rotoresection group and in 3 in the transurethral group.

Conclusions

Rotoresection is a safe and effective method of treating bladder outlet obstruction resulting from benign prostatic hyperplasia, and its efficacy is comparable to transurethral resection of the prostate.

Key Words: transurethral resection of prostate, randomized controlled trials, treatment outcome

Abbreviations and Acronyms: AUA, American Urological Association, BPH, benign prostatic hyperplasia, I-PSS, International Prostate Symptom Score, PdetQmax, detrusor pressure at maximum flow, PVR, post-void residual, Qmax, maximum free flow rate, QoL, quality of life, TURP, transurethral resection of the prostate