الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Benign prostatic hyperplasia (BPH) is a pathologic process that contributes to, but is not the sole cause of, lower urinary tract symptoms (LUTS) in aging men. BPH characterized by an increased number of epithelial and stromal cells in the periurethral area of the prostate and thus correctly referred to as hyperplasia and not hypertrophy.
The exact etiology is unknown; however, the similarity between BPH and the embryonic morphogenesis of the prostate has led to the hypothesis that BPH may result from a “reawakening” in adulthood of embryonic induction processes.
Traditionally, the primary goal of treatment has been to alleviate bothersome LUTS that result from prostatic enlargement. More recently, treatment has additionally been focused on the alteration of disease progression and prevention of complications that can be associated with BPH/LUTS.
The increase in public awareness and the numerous campaigns aiming to get men with LUTS to the specialist further increased the number of BPH cases, especially in those patients with mild and medium symptoms. The scientific and technological evolution led to the development of many non-surgical treatment alternatives, limiting the indications of surgery. Despite all that, there still is a great number of patients with large prostates and severe symptoms or complications of BPH, requiring surgery
The surgical management of patients with large prostate (>60 mL) that cause bladder outflow obstruction (BOO) secondary to benign prostatic hyperplasia (BPH) is a challenging area .
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Endoscopic treatment by transurethral prostatectomy (TURP) has occasionally been used for large adenomas but becomes increasingly difficult and unsafe as prostate volume increases. Modifications of the traditional techniques, such as the use of bipolar technology, removal of only 1 lateral lobe, and various loop modifications have been made to increase the volume of gland that can be safely tackled. Some authors tried TURP for prostate 80 mL and achieved some satisfactory results, and they proposed that TURP can also treat large prostate glands, even greater than 80 ml.
The application of open surgery for BPH has been progressively decreasing over the years after the rapid advent of minimally invasive techniques, including TURP.
Open prostatectomy offers advantages such as a lower retreatment rate, more complete removal of prostate adenomas, and avoidance of TUR syndrome. However, risks of incontinence, retrograde ejaculation, perioperative hemorrhage, and longer hospitalization still remain.
Although newer and more promising techniques are readily available in the daily practice, TURP and open surgery are still the only reliable methods for performing a correct and complete prostatectomy in patients with large prostates.
TURP is considered a minimally invasive technique in comparison with open prostatectomy with fewer catheter and hospital stay in addition to less complications, there is no strong evidence in the literature regarding the upper size limit of the prostate suitable for TURP.
In this study:
TURP for prostate > 60 grams done by high experience urologist showed similar efficacy to open prostatectomy in improving voiding symptoms while
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rendering shorter hospitalizations, a low transfusion rate, and fewer complications.
For low experience urologists, TVP is better than TURP in large prostate in the point of committed complications.
The follow up data at 3 months only is not sufficient to judge the outcome for both techniques so results of long-term studies are also warranted.
It is clear for us that TURP for large prostates is an intervention not to be performed by the beginner endoscopist.
It is also obvious for us that, in the end, the final option is a matter of personal training and experience – there are many urologists who will perform TURP for a large prostate, and there are urologists who will feel safer performing open surgery for a mid-sized prostate. In this aspect, our study proves that the endoscopist who will decide to operate a large prostate is not wrong in his decision and may decide to do two sessions of TURP for a very large prostate.
More studies should be done in management of large prostate by plasma vaporization with pointing to the good results obtained in the managed 2 cases.
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