Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia With Open Prostatectomy: Results of a Contemporary Series

Purpose: Surgical therapy remains the definitive treatment in patients with benign prostatic hyperplasia sequelae. Many patients with a markedly enlarged prostate are often not amenable to minimally invasive therapies. In these patients open prostatectomy is a preferred treatment. Most studies of this procedure are quite dated. Therefore, we describe the clinical results and complications of open prostatectomy performed in a modern setting using serum prostate specific antigen, the American Urological Association symptom index and quality of life scores to determine outcomes. Materials and Methods: We performed a prospective study in 56 patients who underwent open prostatectomy at our institution. Patients were evaluated by history and physical examination, American Urological Association symptom index, quality of life forms, prostate specific antigen, transrectal ultrasound and post-void urine volume. Results: Patients were followed up to 11 years postoperatively (mean 39.2 months). Of the patients 80.3% presented in acute urinary retention while on medical therapy. Baseline American Urological Association symptom index decreased from a mean ± SD of 18.5 ± 1.9 to 4 ± 1.7 within 1 month. Similarly the quality of life score was 3.1 ± 0.5 preoperatively, which decreased to 0.6 ± 0.5 postoperatively. These improvements were maintained throughout followup. The most common complication was blood loss requiring transfusion in approximately 36% of cases. Three patients had urethral strictures and 3 had bladder neck contractures that required dilation. Baseline average prostate specific antigen was 13.34 ± 1.70 ng/dl, which stabilized at less than 1 ng/dl postoperatively. Conclusions: Open prostatectomy may be curative in a select population of men with a large prostatic burden. To our knowledge this is the first study to demonstrate durable improvements in American Urological Association symptom index, quality of life score and prostate specific antigen along with a rare need for any further treatment after open prostatectomy.