A 72-year-old man with benign prostatic hyperplasia and refractory lower urinary tract symptoms is counselled regarding surgical and minimally invasive interventions. All of the following are recognized indications or advantages of transurethral resection of the prostate (TURP) EXCEPT:

Explanation

## Surgical Management of BPH: TURP Indications and Limitations ### Why Option A is the EXCEPT Answer **Key Point:** Option A states that TURP is indicated for prostate glands **<45 g**. This is **incorrect as stated**. According to Campbell-Walsh Urology (12th ed., Ch. 106) and EAU/AUA guidelines, TURP is the standard surgical option for prostates up to **80 g** (some sources cite 60–80 g). The <45 g threshold is an outdated or overly restrictive figure — TURP is routinely performed on glands well above 45 g. Open prostatectomy or laser enucleation (HoLEP) is typically reserved for glands **>80 g**. Therefore, the claim that TURP is indicated only for glands <45 g is factually incorrect and represents the "EXCEPT" answer. ### Recognized Facts About TURP (Options B, C, D) **Option B — TURP Syndrome (TURS):** TURS is a well-recognized complication occurring in 1–8% of TURP cases, caused by systemic absorption of hypotonic irrigation fluid (glycine, sorbitol, or water). Manifestations include: - **Hyponatremia** (Na⁺ <125 mEq/L) - **Cerebral edema** → confusion, restlessness, headache, seizures, coma - **Pulmonary edema**, bradycardia, and hypertension (early), then hypotension This is a **true and recognized** complication of TURP. ✓ **Option C — Gold Standard:** TURP is widely described as the **gold standard** for surgical treatment of bladder outlet obstruction due to BPH. While HoLEP and open prostatectomy may have lower reoperation rates for very large glands, TURP remains the benchmark against which all other procedures are compared. The statement in Option C is a recognized characterization of TURP in standard surgical texts. ✓ **Option D — Durable Symptom Relief:** TURP provides durable symptom relief, with **70–90% of men reporting significant improvement at 5 years** and mean peak urinary flow improving from ~8 mL/s to ~18 mL/s. This is a well-established outcome figure cited in Campbell-Walsh and AUA guidelines. ✓ ### Summary Table: TURP Indications by Prostate Size | Prostate Volume | Recommended Procedure | |---|---| | **<30 g** | TUIP or TURP | | **30–80 g** | **TURP** (standard) | | **>80 g** | Open prostatectomy or HoLEP | **High-Yield:** The correct upper limit for TURP is approximately **80 g**, not 45 g. Stating TURP is indicated only for glands <45 g is the factual error that makes Option A the EXCEPT answer. **Clinical Pearl:** Always remember — TURP is the gold standard for BPH surgery for glands up to ~80 g. The <45 g restriction cited in Option A does not reflect current guidelines (Campbell-Walsh Urology 12e; EAU Guidelines on Non-neurogenic Male LUTS, 2023).