BENIGN prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in middle-aged and older men. While transurethral resection of the prostate (TURP) remains the gold standard for larger prostates, small-volume BPH (SBPH) presents unique challenges. In SBPH, obstruction is often driven by bladder neck fibrosis rather than glandular hyperplasia, reducing the effectiveness of conventional TURP and increasing the risk of postoperative bladder neck contracture.
Tailored Surgical Approach for Small-Volume BPH
To overcome these challenges, a combined procedure of TURP with transurethral incision of the bladder neck (TUIBN) has been implemented. TURP removes hyperplastic tissue, while TUIBN directly releases fibrotic obstruction at the bladder neck. This dual approach addresses the key pathological features of SBPH more effectively than TURP or transurethral incision of the prostate (TUIP) alone.
A recent clinical study found that TURP + TUIBN improves urodynamic parameters, symptom scores, and quality-of-life (QOL) outcomes in patients with small-volume BPH. Intraoperative observations confirmed that fibrotic tissue was effectively released, explaining the lower incidence of postoperative contracture. Importantly, adding the bladder neck incision did not significantly increase complications, such as bleeding, capsular perforation, or transient LUTS, supporting the safety of this method.
This evidence highlights the importance of tailoring surgical interventions to underlying pathology. In small-volume BPH with predominant fibrosis, TURP alone may inadequately relieve obstruction. The TURP + TUIBN combination enhances urinary flow, reduces post-void residual (PVR), and improves patient-reported outcomes, offering superior functional results in this specific population.
In summary, for men with small-volume BPH and bladder neck fibrosis, combining TURP with TUIBN provides a safe, effective, and targeted surgical strategy. By addressing both glandular and fibrotic components, this approach optimises urodynamic outcomes, reduces complications, and improves quality of life, making it a valuable alternative to conventional TURP.
Reference
Yao Z et al. Analysis of the efficacy of transurethral resection of prostate combined with transurethral incision of bladder neck when treating patients with small volume benign prostatic hyperplasia. BMC Urol. 2025;25(1):250.
