Evaluation of Transurethral Incision versus Medical Management in Small-sized Benign Prostatic Hyperplasia: A Prospective Interventional Study

Introduction: Benign Enlargement of Prostate (BEP) is one of the leading causes of Lower Urinary Tract Symptoms (LUTS) in ageing men. Transurethral Incision of the Prostate (TUIP) has emerged as an alternative for managing Bladder Outlet Obstruction (BOO) caused by a small prostate. The management of a small prostate in BPH is still a debated topic with very scant available data and hence, requires further study. Aim: To compare TUIP versus medical management with alpha blockers for small-sized benign enlargement of the prostate in terms of efficacy, safety and outcomes. Materials and Methods: This prospective interventional study was conducted in the Department of Urology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India, over 24 months from June 2023 to June 2025. Patients with proven bladder outlet obstruction with prostate volume <40 cc on Ultrasonography (USG) on USG were included in the study. Group A was given medical management with alpha blockers, and Group B was treated with TUIP. The outcome of the two was compared in terms of improvement in post-void residue, maximum flow rate and International Prostate Symptom Score (IPSS) score and incidence of retrograde ejaculation. The statistical analysis was based on the Chi-square test for categorical variables and the Student’s t-test for continuous variables for comparison of quantitative outcome parameters. A p-value <0.05 was considered statistically significant. Statistical Package for Social Sciences (SPSS) software version 24.0 was used for statistical analysis. Results: Out of 64 patients, the 51-60 year age group had the highest number of participants in both the medical and surgical groups. The mean age was 49.59±6.04 years in the medical group and 50.37±5.79 years in the surgical group. The 36-40 cc category had the highest number of patients in both groups, with the mean prostate size being 35.95±3.02 cc in the medical group and 36.05±2.71 cc in the surgical group. Post Void Residual urine (PVR) was significantly lower in the surgical group (49.06±7.87 mL) compared to the medical group (80.15±12.47 mL), with a mean difference of 31.09 mL, p-value <0.001. Maximum urinary flow rate (Qmax) was significantly higher in the surgical arm (18.37±0.82 mL/s) than in the medical arm (12.55±1.14 mL/s), with a mean difference of -5.81 mL/s (p-value <0.001). International Prostate Symptom Score (IPSS) was markedly lower in the surgical group (6.68±1.55) compared to the medical group (10.46±1.56), with a mean difference of 3.78 points (p-value <0.001). Retrograde ejaculation was observed in 11 (34.37%) of patients receiving medical therapy compared to 4 (12.50%) in the surgical group. Conclusion: The TUIP is a safe and effective alternative to alpha-blockers for the management of LUTS in men with small prostates, providing superior symptom relief and bladder emptying with minimal morbidity and better preservation of sexual function.