Elective hemi transurethral resection of prostate: a safe and effective method of treating huge benign prostatic hyperplasia.

OBJECTIVE: To evaluate the safety and efficacy of elective hemi-resection of prostate in patients with huge gland, weighing more than 120 grams. STUDY DESIGN: Multicentric, analytical comparative study. PLACE AND DURATION OF STUDY: Department of Urology, Karachi Medical and Dental College, Abbasi Shaheed Hospital and Dr. Ziauddin Hospital, Karachi, from August 2006 to July 2009. METHODOLOGY: All benign cases were included in this study and divided into two groups. In group A, patients having hugeprostate (> 120 grams) were placed and hemi TURP was performed. In group B, patients having 60 to 100 grams prostate were placed and conventional Blandy's TURP was performed. Results of both groups were compared in terms of duration of surgery, amount of tissue resected, operative bleeding, postoperative complications, duration of postoperative catheterization, re-admission and re-operations. Effectiveness of procedure was assessed by a simple questionnaire filled by the patients at first month, first year and second year. Patients satisfaction in terms of their ability to void, control urination, frequency, urgency, urge incontinence, haematuria, recurrent UTI, re-admission and re-operations were also assessed. Fisher exact test was applied to compare the safety and efficacy of variables. RESULTS: In group A and B, average age range was 72 and 69 years, average weight of prostate was 148 and 70 grams, average duration of surgery was 102 and 50 minutes respectively. Average weight of resected tissue was 84 and 54 grams and haemoglobin loss was two grams and one gram respectively. Total hospital stay was 5 and 4 days. Total duration of indwelling Foley's catheter (postoperative) was 5 days and 2 days. Patient satisfaction in term of urine flow, urinary control, improvement in frequency and nocturia were comparable in both groups. UTI and re-admission was more in hemiresection group. At the end of 2 years follow-up, there is no statistical difference between the safety and efficacy of two methods of treatment. CONCLUSION: In selected population, elective hemi TURP for huge obstructed prostate is a safe treatment. It's safety and short terms efficacy is comparable with the results of conventional TURP.

Complicated megaureter with aganglionosis in an adult lady.

Dilated ureters are often due to mechanical obstruction. This case report describes a young adult lady with primary megaureter due to aganglionosis finally managed with extravesical Leech-Gregor Uretroneocystostomy.