Retropubic transvesical prostatectomy for significant prostatic enlargement must remain a standard part of urology training

Objective: In recent years, open prostatectomy for benign enlargement has again become an issue of interest. We evaluated our experience with this procedure. Special attention was paid to the effect of the experience of the surgeon on operative outcome. Material and Methods: The patient files of 201 patients were evaluated retrospectively for operation outcome parameters. Statistical analysis was performed where appropriate. The different parameters were also analyzed separately for patients operated on by the head of the department and those operated on by residents. Results: We found significant differences in pre- and postoperative median residual urine volume (85 vs 0.0 ml; p < 0.001) and pre- and postoperative median urinary flow (6.0 vs 20.8 ml/s; p < 0.001). There was a moderate correlation between preoperative determination of the prostate volume by means of transrectal ultrasound and postoperative histological weight. Patients operated on by the head of the department had a significantly shorter operation time. Postoperative complications were rarely seen in either group. The rates of postoperative complications were as follows: permanent incontinence, 0.5%; endoscopic revision (bleeding), 3%; open revision, 1%; urinary tract infection, 13%; and secondary wound healing, 5.5%. Conclusions: We feel that open prostatectomy remains an excellent technique for large prostate adenomas and should always be offered in such cases as a true alternative to endoscopic techniques. Having a well-trained urologist perform the procedure is the best guarantee of minimal blood loss and minimal complication rates. Therefore, open prostatectomy should be part of the education program of all prostate centers and urological departments.