Transurethral Prostatectomy: Review of 1,000 Patients Using Distilled Water as Irrigating Fluid and the Suprapubic Shunt

Objective: To review in 1000 patients the results of the transurethral resection of the prostate (TURP) using distilled water as irrigating fluid and the suprapubic shunt to allow a low bladder pressure procedure. Material and Methods: 1000 patients 36 to 94 years old (average 65 years) with benign hyperplasia submitted to TURP between 1985 and 1999 were retrospectively evaluated for the immediate postoperative complications and the long-term results. The degree of bladder outlet obstruction symptoms (BOO) was the most decisive factor for the resection of the prostate. The Nesbit technique of resection was followed and distilled water was used. Results: Immediate complications in 1000 procedures were: re-insertion of the urethral catheter in 3.8% of them; re-examination for hemorrhage in 1.8%; re-resection in 0.8% and acute renal failure in 0.2%. Blood transfusion was necessary in 0.9% of them, rectum-prostatic fistulae, ileal or prostatic perforation occurred in 0.1% each, and mortality rate was 0.3%. Incidental carcinoma was found in 4.2%. Median follow-up of 32 months (4-168 months) in 803 patients showed bladder neck stenosis in 8.72%, acute epidydimitis in 3.73%, a new TURP in 1.37% and urge or stress incontinence in 1.25%. Patient’s satisfaction was 94.23% after solving the bladder neck/meatal stenosis and the epididymitis. A group of 197 patients followed at least from 5 to 14 years revealed that satisfaction was maintained in 91.6%, a new TURP was necessary in 2.8%, and prostatic carcinoma was detected in 3.9% of them. Conclusion: The TURP for the benign prostatic hyperplasia using distilled water and the suprapubic shunt is a safe, efficient procedure that has few major complications, a low re-operation rate and satisfactory results up to 14 years comparing favorably with other minimally invasive therapies.