Open Prostatectomy Is Still a Valid Option for Large Prostates: A High-Volume, Single-Center Experience

Objectives

To evaluate, in a retrospective, single-center trial, our open prostatectomy outcomes and complications in the past 12 years to emphasize the feasibility of open prostatectomy for large prostates.

Methods

A total of 1193 patients underwent open prostatectomy from 1995 to 2007. We retrospectively analyzed the data from 664 patients who had preoperative, operative, and postoperative data available.

Results

The mean patient age was 67.5 years (range 52–86). The mean preoperative prostate-specific antigen value was 9.6 ng/mL (range 1.65–45.6). The mean prostatic weight was 88.7 g (range 45–324) and was significantly different for the 1995–2001 and 2002–2007 groups (73.6 vs 98.2 g, respectively). Of the 664 patients, 208 (31%) had had an indwelling catheter before surgery. The average International Prostate Symptom Score was 21.7 (range 13–32) preoperatively and 10.6 (range 8–18) postoperatively (P <.005). The average hospitalization was 6.74 days (range 4–14). Blood transfusion was required in 12.7% of the patients either intraoperatively or postoperatively. Postoperatively, 82 patients (12.3%) had urinary tract infections, 22 (3.2%) had bladder neck obstruction, 5 (0.7%) had urinary incontinence, and 15 (2.3%) had a ureteral meatus stricture.

Conclusions

Open prostatectomy is a feasible treatment option for patients with a large prostate and also for patients with additional bladder pathologic findings such as bladder calculi or diverticula for whom endoscopic treatment modalities are not appropriate. Consequently, open prostatectomy is still the primary option for patients with a prostate greater than 100 cm³ and preserves its importance in urology practice, even in the presence of endoscopic innovations.