Abstract
Background. Benign prostatic hyperplasia (BPH) is one of the most common urological conditions in elderly men. Its prevalence increases with age, reaching over 80% in men over 80. When conservative treatment is ineffective, surgery remains the gold standard, particularly for prostates of large volume. However, the effectiveness and safety of various surgical techniques for large and very large prostates (≥80 ml), especially considering anatomical features of the vesico-urethral segment, remain a subject of ongoing investigation. Aim: to compare the long-term outcomes of different surgical techniques for BPH in patients with large and very large prostate volumes, taking into account the anatomical characteristics of the vesico-urethral segment. Materials and methods. A retrospective single-center study was conducted including 563 patients with BPH (prostate volume ≥80 ml) who underwent one of the following procedures between 2019 and 2021: mechanical enucleation (n=106), monopolar TURP (n=51), bipolar TURP (n=302), or transurethral enucleoresection of the prostate (TUERP, n=104). Parameters evaluated included operative time, catheterization duration, hospitalization period, and changes in IPSS, QoL, Qmax, voided volume, post-void residual urine, as well as postoperative complications at 12 months. Results. TUERP showed the most favorable outcomes with the lowest IPSS (7 [6;9]) and QoL (1.5 [1;2]) scores at 12 months, highest Qmax (18.7±2.3 ml/s), lowest residual urine volume (32±12.6 ml), and the shortest hospitalization and catheterization durations. Bipolar TURP also demonstrated good efficacy, although slightly inferior to TUERP in some parameters. Mechanical enucleation, despite removing the largest tissue volume, was associated with longer surgery, extended hospitalization, and higher rates of complications. Monopolar TURP had the least favorable outcomes in terms of symptom relief and postoperative safety. Conclusion. TUERP is the most effective and safe surgical approach for BPH in patients with large and very large prostates, providing optimal urinary function recovery and quality of life improvement with a low rate of complications. Bipolar TURP remains a viable alternative for prostates up to 100 ml. The choice of surgical technique should be individualized based on prostate volume, anatomical characteristics, and the surgeon's expertise