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doi:10.1111/j .1464-410X.2010.09229.x
.Original Articles
10-YEAR FOLLOW-UP AFTER TURP, CONTACT LASER PROSTATECTOMY AND
ELECTROVAPORIZATION FOR BPH
HOEKSTRA
ET AL.
A 10-year follow-up after transurethralresection of the
prostate, contact laserprostatectomy and electrovaporization in
menwith benign prostatic hyperplasia; long-termresults of a
randomized controlled trial
Robert J. Hoekstra, Harm H.E. van Melick*, Esther T. Kok and
J.L.H. Ruud Bosch
Departments of Urology, University Medical Center, Utrecht, and
*Sint Antonius Ziekenhuis, Nieuwegein-Utrecht, the
Netherlands
Accepted for publication 27 November 2009
morbidity and mortality. In 2008 we carried
out a long-term follow-up in these patients.Long-term values
were compared withpreoperative values for each treatment
group (Wilcoxon signed-rank test),differences among groups were
analysed(KruskalWallis test) and actuarial failure-
rates of the interventions were determined(Kaplan-Meier
analysis).
RESULTS
Although we could account for 91% of the
initial participants in 2008, 66 (44%)patients (29 TURP, 20 CLP
and 17 EVAP) wereavailable for follow-up measurements after
a mean (range) of 10.1(6.912.7) yearsAmong the three treatment
groups, therewere no significant differences in IPSS, QoL,
SPI, BII, Q
max
, PSA level and prostate volume.The IPSS, QoL, SPI and BII were
still improved(
P
150 mL. Serum PSA levels
were measured before and at 1 year aftersurgery. Prostate volume
was measured byTRUS before and at 6 months after surgery.
In 2008, we registered mortality, morbidityand re-operation
rates of all prospectively
randomized patients by chart review, history-taking and by
approaching patients GPs. Allmen, who were alive and not
previously
excluded, were invited by letter and ifnecessary by telephone to
visit the outpatientdepartment. The same questionnaires and
tests were used as during the previousstudies. To obtain the
maximum cooperationof patients, we chose to measure prostate
volume by less-invasive transabdominalultrasonography. In some
patients it isdifficult to measure prostate length by this
method because the pubic bone causes ashadow. Therefore we
determined prostatevolume using the prolate spheroid formula,
expressed as
/6
(anteroposterior
dimension)
(transverse dimension)
2
, shownto be an accurate method to estimate
prostate volume by Terris and Stamey [11] andBangma et al.
[12].
To increase the assessment of the durability ofthese surgical
procedures, we studied thelong-term success rates of these
techniques.
We used Kaplan-Meier life-table analysis tocalculate the success
rates and to adjust forincomplete follow-up. Success rate was
defined as 1 failure rate. Failure was definedas: re-operation
(for BPH or urethral stricture)and need for permanent or
intermittent
catheterization. An intent-to-treat analysiswas used; men who
crossed over to the TURPgroup, because of technical (equipment)
failure, were regarded as a failure of the initialtechnique.
Long-term values for the available patientswere compared to
preoperative values foreach treatment group; then differences
between treatment groups were analysed.After examining whether a
variable wasdistributed normally, results were tested for
statistical significance by the Wilcoxonsigned-rank test,
KruskalWallis test and byMannWhitney U
-test. Statistical significance
was indicated at P
