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McConnell JD, Barry MJ, Bruskewitz RC. Benign Prostatic Hyperplasia: Diagnosis and Treatment. Rockville (MD): Agency for Health Care Policy and Research (AHCPR); 1994 Feb. (AHCPR Clinical Practice Guidelines, No. 8.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

Cover of Benign Prostatic Hyperplasia: Diagnosis and Treatment

Benign Prostatic Hyperplasia: Diagnosis and Treatment.

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Attachments

Attachment A. Decision Diagram: Management of BPH

[Diagram]

Introduction

The decision diagram on the following pages is provided as a framework for diagnosis and treatment. It is not intended as a rigid pathway that must be followed in all cases. Individual patients will present in whom deviations from these policies are appropriate. In such circumstances, the health care provider should exercise clinical judgment and act in the patient's best interest.

Explanation of Decision Diagram

The terms recommended, optional, and not recommended indicate degrees of desirability for specific diagnostic interventions. The terms standard, guideline, and option indicate intended degrees of flexibility for treatment policies. Patients with prostate enlargement without symptoms of prostatism should not be evaluated for BPH treatment, but reassessed periodically.

1. Initial Evaluation (Recommended)

  • Detailed History: Urinary tract symptoms, prior urinary tract surgery/ other treatment. Medical disease, to evaluate fitness for BPH treatments.
  • Physical examination: Includes focused neurologic examination as well as digital rectal examination.
  • Digital rectal examination (DRE): Prostate size and/or palpable abnormalities. Anal sphincter tone.
  • Urinalysis: Dipstick (including test of bacteriuria, hematuria, and/or pyuria) or examination of the spun sediment.
  • Creatinine: Elevated value suggests need for upper urinary tract imaging, preferably by ultrasonography.
  • Prostate-specific antigen (PSA): Optional.

2. Prostate Surgery (Guideline)

  • There is a treatment-policy guideline for surgery if any of these urinary tract conditions are present secondary to BPH.

3. Quantitative Symptom Assessment

  • Ask patient to complete AUA Symptom Index questionnaire (Recommended).
  • Put completed AUA form in medical record.

4.Mild Symptoms (Symptom Score = 0-7)

  • Offer watchful waiting only (Standard).
  • Reassure patient.
  • Reassess periodically.
  • Risks outweigh benefits for all treatments except watchful waiting.
  • Most patients prefer watchful waiting.

5. Moderate Symptoms (Symptom Score = 8-19) to Severe Symptoms (Symptom Score = 20-35)

  • Offer treatment options (Guideline.
  • Provide the patient with a copy of Treating Your Enlarged Prostate: Patient Guide (Guideline.
  • Discuss treatment options, including benefits and risks, after patient reads the Patient Guide (Guideline).
  • Moderate symptoms: Wide variation in patient preferences. A substantial number of patients prefer watchful waiting.
  • Severe symptoms: More patients prefer surgery to other treatment options. There is still a wide variation in patient preferences overall.

6. Diagnostic Tests: To Confirm BPH Diagnosis (Optional)

  • Uroflowmetry, pressure-flow studies, postvoid residual urine volume (PVR), if cause of symptoms is uncertain after the initial evaluation.
  • Consider pressure-flow studies if peak flowrate is normal (>15 mL/sec), if patient is at higher risk for a primary bladder problem (known neurologic disease), or in patients for whom a distinction between prostatic obstruction, detrusor instability, and/or impaired detrusor contractility might affect the choice of therapy.

7. Offer Treatment Alternatives

  • Educate patient about each treatment option; give him a copy of Treating Your Enlarged Prostate: Patient Guide (Guideline).
  • Review benefits and risks of each option.
  • Assess patient attitudes toward each treatment option.
  • Help patient to assess treatment options and select one.

8. Watchful Waiting

  • Periodic (probably annual) reassessment: review symptoms (AUA Symptom Index), physical findings, laboratory testing (Guideline).
  • Uroflowmetry and postvoid residual urine determination (Optional).

9. Optional Testing to Plan an Invasive Procedure, Not Used to Determine the Need for Treatment Urethrocystoscopy or transabdominal bladder/prostate ultrasonography to help surgeon plan prostate surgery or balloon dilation by determining prostate size and configuration.

Attachment A: Decision Diagram

Image f3103_bphatta.jpg

Attachment B. Assessment of Treatment Outcomes

Introduction

The number ranges on the Balance Sheet (Attachment B) are 90-percent confidence intervals for the likelihood that a given outcome will follow a given treatment. A wide range indicates that there is considerable uncertainty regarding the likelihood of the outcome.

Explanation of Balance Sheet Table;

Line 1: Likelihood that given patient will experience some symptom improvement; likelihood of improvement greater if pretreatment symptoms more severe. Line 2: Expected amount of improvement (for patients who improve). Line 3: Likelihood that given patient will have treatment complications or adverse events. Line 4: Likelihood that given patient will die due to any causes within 3 months of treatment. Line 5: Likelihood that given patient will experience total incontinence due to the treatment. Line 6: Likelihood that given patient will require surgical correction for a late complication of BPH treatment such as bladder neck contracture or urethral stricture. Line 7: Likelihood that a patient who was potent prior to treatment will experience impotence following treatment. Line 8: Likelihood that a patient who was potent before treatment and still potent after treatment will experience retrograde ejaculation following treatment. Line 9: Estimated number of days a given patient may miss from work during first year of treatment. Line 10: Estimated number of days spent in hospital.

Attachment B. Balance sheet for BPH treatment outcomes

Attachment B. Assessment of Treatment Outcomes

Surgical OptionsNonsurgical Options
Direct treatment outcomesBalloon dilationTUIPOpen surgeryTURPWatchful waitingAlpha blockersFinasteride
Chance for improvement of symptoms (90% confidence interval)37-76%78-83%94-99.8%75-96%31-55%59-86%54-78%
Degree of symptom improvement (percent reduction in symptom score)51%73%79%85%Unknown51%31%
Morbidity/complications associated with surgical or medical treatment (90% from BPH confidence interval), progression about 20% of all complications assumed to be significant1.78-9.86%2.2-33.3%6.98-42.7%5.2-30.7%1-5% complications from BPH progression2.9-43.3%13.6-18.8%
Chance of dying within 30-90 days of treatment (90% confidence interval)0.72-9.78% (high-risk/elderly patients)0.2-1.5%0.99-4.56%0.53-3.31%0.8%chance of death <= 90 days for 67-year-old man
Risk of total urinary incontinence (90% confidence interval)Unknown0.06-1.1%0.34-0.74%0.68-1.4%Incontinence associated with aging
Need for operative treatment for surgical complications in future (90% confidence interval)Unknown1.34-2.65%0.6-14.1%0.65-10.1%0
Risk of impotence (90% confidence interval)No long-term followup available3.9-24.5%4.7-39.2%3.3-34.8%About 2% of men age 67 become impotent per year. Long-term data on alpha blockers are not available.2.5-5.3% (also decreased volume of ejaculate)
Risk of retrograde ejaculation (percent of patients)Unknown6-55%36-95%25-99%04-11%0
Loss of work time (days)47-2121-287-2113.51.5
Hospital stay (days)11-35-103-5000

Attachment C. Articles Reviewed for Combined Analysis of BPH Treatment Outcomes

Placebo

  • Abrams P, Hollister P, Lawrence J, Doyle PT, Sherwood T, Whitaker RH. Bladder outflow obstruction treated with phenoxybenzamine. Preliminary note. Br J Urol 1982;54:530.
  • Abrams PH. Prostatism and prostatectomy: the value of urine flow rate measurement in the preoperative assessment for operation. J Urol 1977;117:70-1.
  • Aubrey DA, Khosla T. The effect of 17-alpha-hydroxy-19-norprogesterone caproate (SH 582) on benign prostatic hypertrophy. Br J Surg 1971;58:648-52.
  • Beacock CJM, Buck AC, Roberts EE. Bifluranol in the treatment of benign prostatic hyperplasia (BPH). Prostate 1985;7:357-61.
  • Becker H, Ebeling L. Konservative therapie der benignen prostata-hyperplasie (BPH) mit Cernilton N. Ergebnisse einer plazebokontrollierten doppelblindstudie. Urologe [B]1988;28:301-6. (Ger).
  • Bonard M, de Almeida S, von Niederhausern W. Placebo-controlled double-blind study in human benign obstructive prostatic hypertrophy with flutamide. Eur Urol 1976;2(1):24-8.
  • Brooks ME, Sidi AA, Hanani Y, Braf ZF. Ineffectiveness of phenoxybenzamine in treatment of benign prostatic hypertrophy. A controlled study. Urology 1983;21:474-8.
  • Buck AC, Cox R, Rees RWM, Ebling L, John A. Treatment of outflow tract obstruction due to benign prostatic hyperplasia with the pollen extract, Cernilton. A double-blind, placebo-controlled study. Br J Urol 1990;66:398-404.
  • Caine M, Perlberg S, Gordon R. The treatment of benign prostatic hypertrophy with flutamide (SCH 13521): a placebo-controlled study. J Urol 1975;114:564-8.
  • Caine M, Perlberg S, Meretyk S. A placebo-controlled double-blind study of the effect of phenoxybenzamine in benign prostatic obstruction. Br J Urol 1978;50:551-4.
  • Carbin B-E, Larsson B, Lindahl O. Treatment of benign prostatic hyperplasia with phytosterols. Br J Urol 1990;66:639-41.
  • Castro JE, Griffiths HJL, Edwards DE. A double-blind, controlled, clinical trial of spironolactone for benign prostatic hypertrophy. Br J Surg 1971;58(7):485-9.
  • Champault G, Patel JC, Bonnard AM. A double-blind trial of an extract of the plant Serenoa repens in benign prostatic hyperplasia. Br J Clin Pharmacol 1984;18:461-2.
  • Chow W, Hahn D, Sandhu D, Slaney P, Henshaw R, Das G, Wells P. Multicentre controlled trial of indoramin in the symptomatic relief of benign prostatic hypertrophy. Br J Urol 1990;65:36-8.
  • Donkervoort T, Zinner NR, Sterling AM, Donker PJ, Van Ness J, Ritter RC. Megestrol acetate in treatment of benign prostatic hypertrophy. Urology 1975;6:580-7.
  • Ebbinghaus KD, Baur MP. Egrebnisse einer doppelblindstudie ueber die nirksambeit eines medikamentes zur konservativen behandlung des prostata-adenoms. ZFA 1977;53:1054-8. (Ger).
  • Farrar DJ. Pryor JS. The effect of bromocriptine in patients with benign prostatic hypertrophy. Br J Urol 1976;48:73-5.
  • Geller J, Nelson CG, Albert JD, Pratt C. Effect of megestrol acetate on uroflow rates in patients with benign prostatic hypertrophy: double-blind study. Urology 1979;14:467-74.
  • Goodwin MI, Chester JF, Jenkins JD. Acute urinary retention secondary to benign prostatic hyperplasia. Effect of alpha-adrenergic blockade. Urol Int 1986;41:430-1.
  • Hedlund H, Andersson K-E, Ek A. Effects of prazosin in patients with benign prostatic obstruction. J Urol 1983;130:275-8.
  • Iacovou JW, Dunn M. Indoramin-an effective new drug in the management of bladder outflow obstruction. Br J Urol 1987;60:526-8.
  • Jardin A, Bensadoun H, Delauche-Cavallier MC, Attali P, and the BPH-ALF Group. Alfuzosin for treatment of benign prostatic hypertrophy. Lancet 1991;337:1457-61.
  • Jensen KM-E, Madsen PO. Candicidin treatment of prostatism: a prospective double-blind placebo-controlled study. Urol Res 1983;11:7-10.
  • Kadow C, Abrams PH. A double-blind trial of the effect of beta-sitosteryl glucoside (NA184) in the treatment of benign prostatic hyperplasia. Eur Urol 1986;12:187-9.
  • Kawabe K, Ueno A, Takimoto Y, Aso Y, Kato H, and YM617 clinical study group. Use of an alpha 1-blocker, YM617, in the treatment of benign prostatic hypertrophy. J Urol 1990;144:908-12.
  • Kirby RS, Coppinger SWC, Corcoran MO, Chapple CR, Flannigan M, Milroy EJG. Prazosin in the treatment of prostatic obstruction. A placebo-controlled study. Br J Urol 1987;60:136-42.
  • Klein LA, Lemming B. Balloon dilatation for prostatic obstruction. Long-term follow-up. Urology 1989;33:198-201.
  • Lindner A, Siegel YI, Saranga R, Korzcak D, Matzkin H, Braf Z. Complications in hyperthermia treatment of benign prostatic hyperplasia. J Urol 1990;144:1390-2.
  • Madsen PO, Dorflinger T, Frimodt-Mller PC, Jensen KM-E. Candicidin in treatment of benign prostatic hypertrophy. J Urol 1984;132:1235-8.
  • Martorana G, Giberti C, Damonte P, Ciprandi G, Dirienzo W, Giuliana L. The effect of prazosin in benign prostatic hypertrophy, a placebo controlled double-blind study. IRCS Med Science 1984;12:11-2.
  • Matos-Ferreira A, Corte-Real J, Palma J, Durao V. The effect of bromocriptine in benign prostatic hypertrophy and vesicosphincteric dynamics. Br J Urol 1987;60:143-9.
  • Orkin L. Efficacy of candicidin in benign prostatic hypertrophy. Urology 1974;4(1):80-4.
  • Ostri P, Swartz R, Meyhoff H-H, Petersen JH, Lindgard G, Frimodt-Moller C, Andersson T, Nielsen MS. Antiandrogenic treatment of benign prostatic hyperplasia: a placebo controlled trial. Urol Res 1989;17:29-33.
  • Ramsay JW, Scott GI, Whitfield HN. A double-blind controlled trial of a new a-1 blocking drug in the treatment of bladder outflow obstruction. Br J Urol 1985;57:657-9.
  • Resnick MI, Jackson JE, Watts LE, Boyce WH. Assessment of the antihypercholesterolemic drug, Probucol, in benign prostatic hyperplasia. J Urol 1983;129:206-9.
  • Ronchi F, Margonato A, Ceccardi R, Rigatti P, Rossini BM. Symptomatic treatment of benign prostatic obstruction with nicergoline: a placebo controlled clinical study and urodynamic evaluation. Urol Res 1982;10:131-4.
  • Ruutu ML, Hansson E, Juusela HE, Permi JE, Rusk JI, Sotarauta MT, Talja MT, Wuokko EJ, Mattila MJ. Efficacy and side-effects of prazosin as a symptomatic treatment of benign prostatic obstruction. Scand J Urol Nephrol 1991;25:15-9.
  • Sertcelik MN, Unal S, Ozgur S, Imamoglu A. Prazosin, a selective alpha, receptor blocker, in the treatment of benign prostatic hypertrophy. Curr Ther Res 1990;48:1066-74.
  • Shilcher H, Sauter M, Janssen H. Zum wirksamkeitsnachweis von phytopharmaka am beispeil von prosta-fink. Arztezeitschrift fuer naturheilverfahren. 1985;26(3)177-82. (Ger).
  • Smith HR, Memon A, Smart CJ, Dewbury K. The value of permixon in benign prostatic hypertrophy. Br J Urol 1986;58:36-40.
  • Sonnenschein R. Untersuchungen der wirksamkeit eines prostatotropen phytotherapeutikums (urtica plus) bei benigner prostatahyperplasie und prostatitis-eine prospektive multizentrische studie. Urologe [B] 1987;27:232-7. (Ger).
  • Sporer A, Cohen G, Kamat MH, Seebode JJ. Candicidin physiologic effect on prostate. Urology 1975;6(3):298-304.
  • Stone NN. Flutamide in treatment of benign prostatic hypertrophy. Urology (Suppl 4) 1989;34:64-8;discussion 87-96.
  • Van Poppel H, Boeckx G, Westlinck KJ, Vereecben RL, Baert L. The efficacy of bromocriptine in benign prostatic hypertrophy. A double-blind study. Br J Urol 1987;60(2):150-2.
  • Vontobel, HP, Herzog R, Rutishauser G, Kres H. Ergelnisse einer doppelblinddstudie ueber die wirksamkeit von ERU kapseln in der kinservativen behandlung der benignen prostatahyperplasie. Urologe [A] 1985;24:49-51. (Ger).

Watchful Waiting

  • Ball AJ, Feneley RCL, Abrams PH. The natural history of untreated "prostatism." Br J Urol 1981;53:613-6.
  • Birkhoff JD, Wiederhorn AR, Hamilton ML, Zinsser HH. Natural history of benign prostatic hypertrophy and acute urinary retention. Urology 1976;7:48-52.
  • Clarke R. The prostate and the endocrines: a control series. Br J Urol 1937;9:254-71.
  • Craigen AA, Hickling JB, Saunders CR, Carpenter RG. Natural history of prostatic obstruction. J R Coll Gen Pract. 1969;18:226-32.
  • Kadow C, Feneley RCL, Abrams PH. Prostatectomy or conservative management in the treatment of benign prostatic hypertrophy? Br J Urol 1988;61:432-4.

Alpha Blockers

  • Abrams P, Hollister P, Lawrence J, Doyle PT, Sherwood T, Whitaker RH. Bladder outflow obstruction treated with phenoxybenzamine. Preliminary note. Br J Urol 1982;54:530. Boreham PF, Braithwaite P, Milewski P, Pearson H. Alpha-adrenergic blockers in prostatism. Br J Surg 1977;64:756-7.
  • Brooks ME, Sidi AA, Hanani Y, Braf ZF. Ineffectiveness of phenoxybenzamine in treatment of benign prostatic hypertrophy. A controlled study. Urology 1983;21:474-8.
  • Caine M, Perlberg S, Meretyk S. A placebo-controlled double-blind study of the effect of phenoxybenzamine in benign prostatic obstruction. Br J Urol 1978;50:551-4.
  • Caine M, Perlberg S, Shapiro A. Phenoxybenzamine for benign prostatic obstruction. Review of 200 cases. Urology 1981;17:542-6.
  • Chow W, Hahn D, Sandhu D, Slaney P, Henshaw R, Das G, Wells P. Multicentre controlled trial of indoramin in the symptomatic relief of benign prostatic hypertrophy. Br J Urol 1990;65:36-8.
  • Dunzendorfer U. Clinical experience: symptomatic management of BPH with terazosin. Urology (6 Suppl) 1988;32:27-31.
  • Fabricius PG, Weizert P, Dunzendorfer U, Hannaford JM, Maurath C. Efficacy of once-a-day terazosin in benign prostatic hyperplasia: a randomized, double-blind placebo-controlled clinical trial. Prostate (Suppl) 1990;3:85-93.
  • Gerstenberg T, Blaabjerg J, Nielsen ML, Clausen S. Phenoxybenzamine reduces bladder outlet obstruction in benign prostatic hyperplasia. A urodynamic investigation. Invest Urol 1980;18:29-31.
  • Goodwin MI, Chester JF, Jenkins JD. Acute urinary retention secondary to benign prostatic hyperplasia. Effect of alpha-adrenergic blockade. Urol Int 1986;41:430-1.
  • Hedlund H, Andersson K-E, Ek A. Effects of prazosin in patients with benign prostatic obstruction. J Urol 1983;130:275-8.
  • Iacovou JW, Dunn M. Indoramin-an effective new drug in the management of bladder outflow obstruction. Br J Urol 1987;60:526-8.
  • Jardin A, Bensadoun H, Delauche-Cavallier MC, Attali P, and the BPH-ALF Group. Alfuzosin for treatment of benign prostatic hypertrophy. Lancet 1991;337:1457-61.
  • Kawabe K, Niijima T. Use of an alpha 1-blocker, YM-12617, in micturition difficulty. Urol Int 1987;42:280-4.
  • Kawabe K, Ueno A, Takimoto Y, Aso Y, Kato H, and YM617 clinical study group. Use of an alpha 1-blocker, YM617, in the treatment of benign prostatic hypertrophy. J Urol 1990;144:908-12.
  • Kirby RS, Coppinger SWC, Corcoran MO, Chapple CR, Flannigan M, Milroy EJG. Prazosin in the treatment of prostatic obstruction. A placebo-controlled study. Br J Urol 1987;60:136-42.
  • Lepor H, Knapp-Maloney G, Sunshine H. A dose titration study evaluating terazosin, a selective, once-a-day alpha-1-blocker for the treatment of symptomatic benign prostatic hyperplasia. J Urol 1990;144:1393-8.
  • Lepor H, Henry D, Laddu AR. The efficacy and safety of terazosin for the treatment of symptomatic BPH. Prostate 1991;18:345-55.
  • Lepor H, Knapp-Maloney G. Outcome assessment of terazosin for benign prostatic hyperplasia (BPH): 18 month follow-up. Abstract #204. J Urol (Suppl) 1991;145:263A.
  • Martorana G, Giberti C, Damonte P, Ciprandi G, Dirienzo W, Giuliana L. The effect of prazosin in benign prostatic hypertrophy, a placebo controlled double-blind study. IRCS Med Science 1984;12:11-2.
  • Ramsay JW, Scott GI, Whitfield HN. A double-blind controlled trial of a new a-1 blocking drug in the treatment of bladder outflow obstruction. Br J Urol 1985;57:657-9.
  • Ronchi F, Margonato A, Ceccardi R, Rigatti P, Rossini BM. Symptomatic treatment of benign prostatic obstruction with nicergoline: a placebo controlled clinical study and urodynamic evaluation. Urol Res 1982;10:131-4.
  • Ruutu ML, Hansson E, Juusela HE, Permi JE, Rusk JI, Sotarauta MT, Talja MT, Wuokko EJ, Mattila MJ. Efficacy and side-effects of prazosin as a symptomatic treatment of benign prostatic obstruction. Scand J Urol Nephrol 1991;25:15-9.
  • Sertcelik MN, Unal S, Ozgur S, Imamoglu A. Prazosin, a selective alpha, receptor blocker, in the treatment of benign prostatic hypertrophy. Curr Ther Res 1990;48:1066-74.

Finasteride

The BPH panel performed the analysis on data submitted to the Food and Drug Administration that have subsequently been published in the following papers:

  • Gormley GJ, Stoner E, Bruskewitz RC, Imperato-McGinley J, Walsh PC, McConnell JD, Andriole GL, Geller J, Bracken BR, Tenover JS, Vaughan ED, Pappas F, Taylor A, Binkowitz B, Ng J, et al. The effect of finasteride in men with benign prostatic hyperplasia. N Engl J Med 1992;327:1185-91.
  • Finasteride Study Group. Finasteride (MK-906) in the treatment of benign prostatic hyperplasia. Prostate 1993;22:291-9.

Balloon Dilation

  • Castaneda F, Reddy P, Wasserman N, Hulbert J, Lund G, Letourneau JG, Hunter DW, Castaneda-Zuniga WR, Amplatz K. Benign prostatic hypertrophy: retrograde transurethral dilation of the prostatic urethra in humans. Work in progress. Radiology 1987;163:649-53.
  • Daughtry JD, Rodan BA, Bean WJ. Balloon dilation of prostatic urethra. Urology 1990;36:203-9.
  • Gill KP, Machan LS, Allison DJ, Williams G. Bladder outflow tract obstruction and urinary retention from benign prostatic hypertrophy treated by balloon dilatation. Br J Urol 1989;64:618-22.
  • Goldenberg SL, Perez-Marrero RA, Lee LM, Emerson L. Endoscopic balloon dilation of the prostate: early experience. J Urol 1990;144:83-9.
  • Keane PF, Charig CR, Hudd C, Shah PJR, Kellett MJ, Boyle J, Wickham JEA, O'Donoghue EPN. Balloon dilatation of the prostate: technique and early results. Br J Urol 1990;65:354-6.
  • Klein L, Perez-Marrero R, Bowers GW, Ludwig JJ, Herwig K. Transurethral cystoscopic balloon dilation of the prostate. J Endourol 1990;4(2):183-91.
  • Klein LA, Lemming B. Balloon dilatation for prostatic obstruction. Long-term follow-up. Urology 1989;33:198-201.
  • Lepor H, Sypherd D, Machi G, Derus J. Randomized double-blind study comparing the effectiveness of balloon dilation of the prostate and cystoscopy for the treatment of symptomatic benign prostatic hyperplasia. J Urol 1992;147(3):639-44.
  • McLoughlin J, Keane PF, Jager R, Gill KP, Machann L, Williams G. Dilatation of the prostatic urethra with 35 mm balloon. Br J Urol 1991;67:177-81.
  • Wasserman NF, Reddy PK, Zhang G, Berg PA. Experimental treatment of benign prostatic hyperplasia with transurethral balloon dilation of the prostate: preliminary study of 73 humans. Radiology 1990;177:485-94.

TUIP

  • D'Ancona CAL, Netto NR Jr, Cara AM, Ikari O. Internal urethrotomy of the prostatic urethra or transurethral resection in benign prostatic hyperplasia. J Urol 1990;144:918-20.
  • Delaere KPJ, Debruyne FMJ, Moonen WA. Extended bladder neck incision for outflow obstruction in male patients. Br J Urol 1983;55:225-8.
  • Dorflinger T, Oster M, Larsen JF, Walter S, Krarup T. Transurethral prostatectomy or incision of the prostate in the treatment of prostatism caused by small benign prostates. Scand J Urol Nephrol (Suppl) 1987;104:77-81.
  • Edwards LE, Bucknall TE, Pittam MR, Richardson DR, Stanek J. Transurethral resection of the prostate and bladder neck incision: a review of 700 cases. Br J Urol 1985;57:168-71.
  • Hedlund H, Ek A. Ejaculation and sexual function after endoscopic bladder neck incision. Br J Urol 1985;57:164-7.
  • HellstrOm P, Lukkarinen O, Kontturi M. Bladder neck incision or transurethral electroresection for the treatment of urinary obstruction caused by a small benign prostate? A randomized urodynamic study. Scand J Urol Nephrol 1986;20:187-92.
  • Katz PG, Greenstein A, Ratliff JE, Marks S, Guice J. Transurethral incision of the bladder neck and prostate. J Urol 1990;144:694-6.
  • Kelly MJ, Roskamp D, Leach GE. Transurethral incision of the prostate: a preoperative and postoperative analysis of symptoms and urodynamic findings. J Urol 1989;142:1507-9.
  • Larsen EH, Dorflinger T, Gasser TC, Graversen PH, Bruskewitz RC. Transurethral incision versus transurethral resection of the prostate for the treatment of benign prostatic hypertrophy. A preliminary report. Scand J Urol Nephrol (Suppl) 1987;104:83-6.
  • Li MK, Ng ASM. Bladder neck resection and transurethral resection of the prostate: a randomized prospective trial. J Urol 1987;138:807-9.
  • Mobb GE, Moisey CU. Long-term follow-up of unilateral bladder neck incision. Br J Urol 1988;62:160-2.
  • Nielsen HO. Transurethral prostatotomy versus transurethral prostatectomy in benign prostatic hypertrophy. A prospective randomised study. Br J Urol 1988;61:435-8.
  • Orandi A. Transurethral incision of prostate (TUIP): 646 cases in 15 years -- a chronological appraisal. Br J Urol 1985;57:703-7.
  • Orandi A. Transurethral incision of prostate compared with transurethral resection of prostate in 132 matching cases. J Urol 1987;138:810-5.
  • Orandi A. Transurethral resection versus transurethral incision of the prostate. Urol Clin North Am 1990;17:601-12.

TURP

  • Aalkjer V. Transurethral resection/prostatectomy versus dilatation treatment in hypertrophy of the prostate II. Urol Int 1965;20:17-22. Abrams PH, Farrar DJ, Turner-Warwick RT, Whiteside CG, Feneley RC. The results of prostatectomy: a symptomatic and urodynamic analysis of 152 patients. J Urol 1979;121:640-2.
  • Ball AJ, Smith PJB. The long-term effects of prostatectomy: a uroflowmetric analysis. J Urol 1982;128:538-40.
  • Bandhauer K. Transurethral prostatectomy-complications. N Dev Biosc 1989;5:81-7.
  • Bruskewitz RC, Larsen EH, Madsen PO, Dorflinger T. 3-year followup of urinary symptoms after transurethral resection of the prostate. J Urol 1986;136:613-5.
  • Chilton CP, Morgan RJ, England HR, Paris AMI, Blandy JP. A critical evaluation of the results of transurethral resection of the prostate. Br J Urol 1978;50:542-6.
  • D'Ancona CAL, Netto NR Jr, Cara AM, Ikari O. Internal urethrotomy of the prostatic urethra or transurethral resection in benign prostatic hyperplasia. J Urol 1990;144:918-20.
  • Dorflinger T, Oster M, Larsen JF, Walter S, Krarup T. Transurethral prostatectomy or incision of the prostate in the treatment of prostatism caused by small benign prostates. Scand J Urol Nephrol (Suppl) 1987;104:77-81.
  • Edwards LE, Bucknall TE, Pittam MR, Richardson DR, Stanek J. Transurethral resection of the prostate and bladder neck incision: a review of 700 cases. Br J Urol 1985;57:168-71.
  • HellstrOm P, Lukkarinen O, Kontturi M. Bladder neck incision or transurethral electroresection for the treatment of urinary obstruction caused by a small benign prostate? A randomized urodynamic study. Scand J Urol Nephrol 1986;20:187-92.
  • Holtgrewe HL, Valk WL. Late results of transurethral prostatectomy. J Urol 1964;92:51-5.
  • Kadow C, Feneley RCL, Abrams PH. Prostatectomy or conservative management in the treatment of benign prostatic hypertrophy? Br J Urol 1988;61:432-4.
  • Larsen EH, Dorflinger T, Gasser TC, Graversen PH, Bruskewitz RC. Transurethral incision versus transurethral resection of the prostate for the treatment of benign prostatic hypertrophy. A preliminary report. Scand J Urol Nephrol (Suppl) 1987;104:83-6.
  • Lentz HC, Mebust WK, Foret JD, Melchior J. Urethral strictures following transurethral prostatectomy: review of 2,223 resections. J Urol 1977;117:194-6.
  • Lepor H, Rigaud G. The efficacy of transurethral resection of the prostate in men with moderate symptoms of prostatism. J Urol 1990;143(3):533-7.
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Attachment D. Incidence of Urethral Stricture and Bladder Neck Contracture

Attachment D. Incidence of Urethral Stricture and Bladder Neck Contracture

Attachment D. Incidence of Urethral Stricture and Bladder Neck Contracture.

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Attachment D. Incidence of Urethral Stricture and Bladder Neck Contracture.

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