Goldstandard TUR-P: the bigger the volume, the higher the speed, but resected volumes of more than 60g are critical

According to the European Association of Urology guidelines, the limit for monopolar, transurethral resection (M-TURP) in BPH- therapy is a volume of 80 g. However, whether larger prostates can also be resected transurethrally might also depend on the experience of the surgeon and especially the resected volume and speed of the resection. Little is known about the latter, and this paper aims to these factors.

This study included 540 patients who received a single-stage M-TURP. Based on the postoperative resection weight, these were divided into four groups: group 1 with 10 to 59.9 g, group 2 with 60 to 79.9 g, group 3 with 80 to 99.9 g, and group 4 with ≥ 100 g. We examined patient age, the ASA-score, the IPSS, quality of life, resection weight, time and speed, pre- and postoperative hemoglobin and serum sodium values, complications, and surgeon experience.

The mean resection weight was 41.6 g, and the mean values for resection time and speed were 61.3 min and 0.7 g/min, respectively. The resection speed increased significantly with resection weight (from 0.7 to 1.3 g/min) as well as with the surgeon’s level of experience (from 0.4 to 0.9 g/min). The number of serious complications (Clavien–Dindo ≥ IIIb) increased significantly from a resection volume of 59.5 g (cut-off value).

The resection speed of M-TURP increased significantly with the resection weight and the surgeon's level of experience. Regardless of speed, resection weight of more than 60 g might increase the risk of severe complications.