Transurethral Resection of Prostate (TURP) and Vesicolithotomy for Large Bladder Stone in Single Session: The Third World Perspective

OBJECTIVE: To study the effectiveness and safety of combined transurethral resection of prostate (TURP) and open vesicolithotomy in patients with benign prostatic hyperplasia and massive vesical calculi in a single session. METHODS: A descriptive study conducted at the Institute of Kidney and Diseases, Peshawar Pakistan from March 2013 till December 2019. In total, 43 patients were selected by nonprobability conventional sampling. We included patients with occluding enlarged prostate size of 30–60g and bladder stones of more than 35 mm which was not amenable to cystolitholapaxy or cystolithotripsy. Conventional TURP followed by formal vesicolithotomy was performed in all patients in a single session. All the preoperative, perioperative and postoperative data were documented on structured Proforma. The data analysis was done on SPSS. RESULTS: The average age of the patients included was 65 ±7.5 years. Mean size of prostate was 45.5±6.8 g and mean stone size was 38.4±4.2 mm. The majority of patients [60.4% (n=26)] presented with refractory urinary retention. On average the operation time was 66.3±5.5 minutes. The mean resected volume of prostate was 23.5±6.8g and the average hospital stay was 5.5±1.2 days. Mean trial of removal of catheter was 5±0.6 days. The trial of removal of catheter was successful in all patients. Significant improvement in maximum flow and average flow was recorded in all patients (p = 0.001). On average, the complication rate noted was 6.9% (n = 3). There was no need for blood transfusion. No mortality was recorded in the study. CONCLUSION: The combined TURP and open vesicolithotomy in a single session is an efficacious, safe and viable treatment modality for large bladder calculi secondary to moderately enlarged prostate.