TURP for BPH. How large is too large?

BPH remains one of the most common diseases that the urologist has to manage. The last decade brought numerous new techniques, aiming to improve the minimally invasive approach to BPH, but, for the moment, none had changed the place of TURP as the gold standard treatment for medium sized prostates. Based on a large personal experience, the authors present a study in which TURP is used for prostates over 80 ml, the cutoff point set by the guidelines of the European Association of Urology. The rationale for this study is that many situations require minimally invasive treatment, based on the express request of the patient, other conditions that makes open surgery very difficult or impossible, or the need for a quick discharge in an overcrowded service. The aim of the study was to prove that TURP is safe and effective even in larger prostates. The technique used is basically the classic one, with minor tactical alterations in some cases. Some cases required a two-stage approach, but offered good functional results after the first stage. The results proved that, with a good technique, a skilled urologist might achieve the same results by using TURP or open surgery for large sized prostates.

[Topical immunotherapy with BCG in the adjuvant treatment of superficial bladder tumors--15-year-experience]. / Imunoterapia topica cu BCG în tratamentul adjuvant al tumorilor vezicale superficiale (TVS)--15 ani de experienta.

Between September 1984 and June 1999 we applied a long-term (3 years) protocol treatment (Pasteur strain produced by Cantacuzino Institute) in superficial bladder tumors (SBT) recurrence prophylaxis. In 1014 cases (pTa--11 cases, pT1G1--607 cases, pT1G2--149 cases, pT1G3--247 cases) our retrospective analysis used a personal protocol: 8 weekly intravesical instillations, then monthly instillations until 1 year, then 3 monthly instillations during the following 2 years. Pathologic bladder mucosa (simple, moderate and severe dysplasia, carcinoma in situ) was associated in over 80% of cases. Mean follow-up period was 118 months (range 174 to 6 months). Our results demonstrated the efficiency of this protocol (29.5% recurrences on 840 cases who had complete therapy). The importance of tumoral grading was clearly found: 13% recurrence rate for pT1G1, 39.5% for pT1G2 and 49% for pT1G3. Side-effects (local--78%, systemic--4%) and complications (3%) were treated by symptomatic or antituberculous drugs. Our significative study revealed that intravesical immunotherapy (with BCG vaccine) can be considered the first choice in the complementary treatment of SBT.