Transurethral Resection of the Prostate
After five years’ experience with transurethral resection of the prostate, it seems worth while to evaluate our results. When the method was revived with new interest about five years ago, there was much controversy regarding its merit and the advisability of its use, but the test of experience has shown that the operation has met all requirements and has won a permanent place in the surgical treatment of bladder neck obstructions. This review includes the results secured in a series of 453 transurethral resections which I have performed; 62 were done for carcinoma of the prostate and 391 for various types of benign hypertrophy.
Prostatic obstructions are of two main types: (1) malignant and (2) benign. The former is recognized by the characteristic hard, nodular, fixed prostate, often with extension up toward the seminal vesicles. The clinical history usually reveals obstructive symptoms of relatively short duration (6 months to 1 year) which have then developed fairly rapidly. Marked bladder irritability is also suggestive of this type of obstruction.
The benign hypertrophies are subdivided further according to which of the lobes predominate. Thus, we have solitary middle lobe hypertrophy, simple bilateral lobe hypertrophy, the combined bilateral and middle lobe enlargement and, in addition, the sclerotic or glandular median bars. In these benign enlargements, the clinical history is of long duration, the earliest symptoms being increased frequency with some hesitancy in starting the stream, diminished force and nocturia. These symptoms gradually increase over a period of years until complete urinary retention finally. . .