Grade I benign prostate with outflow obstruction is best treated with -

• MC indication for surgery is symptoms interfering with quality of life (bothersome symptoms and symptoms of BOO). • TURP (Gold standard) : −− Cystoscopic removal of strips of prostatic tissue using diathermy loop. Two techniques; NESBIT technique (preferred maver mayer technique) −− Best irrigant fluid is 1.5% glycine (Electrolyte solutions like NaCl are not compatible with electrocautery, so not used). −− Glycine is composed of glycolic acid and ammonium, which can cause CNS (visual) toxicity. TURIS: TUR in saline using bipolar cautery • Verumontanum is the single most important anatomical landmark in TURP. • Verumontanum lies immediately proximal to external sphincter and serve as the distal landmark for prostate resection to prevent injury to the external sphincter. • Verumontanum: Distal landmark for prostate resection. • Verumontanum: Landmark for proximal limit of external sphincter. −− Risks of TURP: Retrograde ejaculation (75%)Q, impotence (5–10%) and incontinence (< 1%). −− Complications: Bleeding, urethral stricture or bladder neck contracture, perforation of the prostate capsule with extravasation, and if severe, TUR syndrome. TUR syndrome (Dilutional hyponatremia or water intoxication) • TUR syndrome (Dilutional hyponatremia or water intoxication) resulting from a hypervolemic, hyponatremic state due to absorption of the hypotonic irrigating solution. • Clinical Features: Nausea, vomiting, confusion, hypertension, bradycardia, and visual disturbances. • The risk increases with resection times > 90 minutes or gland size > 75 gm. • Treatment includes diuresis (furosemide) and in severe cases, hypertonic saline (3%) administration. Late Complications of TURP • Bladder neck stenosis (4%) > Urethral stricture (3.6%) • Bladder neck stenosis is seen more often with small (< 30 gm) fibrotic prostates. • Transurethral incision of the prostate (TUIP): −− For posterior commissure hyperplasia (elevated bladder neck), involves two incisions using the Collins knife at the 5- and 7-o’clock positions. −− The incisions are started just distal to the ureteral orifices and are extended outward to the verumontanum. • TUIP lowers the incidence of bladder neck contracture when compared to TURP, so TUIP should be strongly considered in patients with smaller gland in place of TURP. • TUIP is used for smaller (20 gm) prostate, young patients. • Decreased incidence of retrograde ejaculation as compared to TURP. • Open simple prostatectomy: Glands > 75 gm, concomitant bladder diverticulum or a bladder stone or if dorsal lithotomy positioning is not possible. −− Suprapubic prostatectomy: Performed transvesically (Frayer’s) and operation of choice in dealing with concomitant bladder pathology (Bladder stones or diverticulum). −− Retropubic prostatectomy (Millin’s): Transverse incision is made in surgical capsule of prostate and enucleation is done. −− Perineal prostatectomy (Youngs): Abandoned now • Carcinoma prostate originates in peripheral zone of prostate, so prostatectomy for BPH confers no protection for subsequent cancer.