***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In a prospect i ve , r and omized study 60 patients with prostatism caused by small prostate gl and s ( estimated weight < 20 g ) had either transurethral prostatectomy ( TURP , n = 31 ) or transurethral incision of the prostate ( TUI  , n = 29 ) . Operating time and blood loss were significantly less in the group that underwent TUI . There were no differences between the groups in number of days with an indwelling catheter or days in hospital after operation . Eight patients in the TUI group required further operation , as did four in the TURP group , one of whom was discharged with a permanent indwelling catheter . In addition one patient developed a urethral stricture . Nine of the failures of treatment occurred within the first month . Fifty-one patients were followed up at 3 months and 47 were also seen at 12 months . Both operations significantly improved symptom scores and maximum flow rates compared with preoperatively , but the improvement in maximum flow rate was significantly better in the TURP group than in the TUI group . At 12 months TURP had also improved micturition time and voided volume , which TUI had not . Neither operation caused any significant change in sexual activity or erective potency postoperatively . Retro grade ejaculation was , however , seen in more than half of the patients in the TURP group , and only one in the TUI group . We recommend TUI for the treatment of prostatism caused by small prostate gl and s in patients who want to preserve normal ejaculation or are at poor surgical risk Each of the treatment alternatives of benign prostatic hyperplasia ( BPH ) has its own advantages and disadvantages . The needs and the condition of the patient should be considered in choosing the proper treatment . After the treatment , patient satisfaction should also be considered because objective criteria do not always reflect the efficacy of the treatment . The long-term efficacy of the three alternative treatments of BPH ( TURP , TUIP , TUBDP ) were compared in a total of 60 men with obstructive symptoms .  TUIP was found to be the method of treatment we recommended in young patients with a small and symptomatic adenoma , whereas TURP is still the ' gold st and ard ' Neodymium laser ( Nd : YAG ) has been used for prostatic coagulation . New contact tips have been developed in order to cause vaporization of the prostate . With the objective to examine the effectiveness and safety of 2 new laser procedures . ITT ( interstitial thermotherapy ) and Sidefocus Technique , in patients with BPH , we have participated in a prospect i ve , international , multicenter study comparing these technique with TURP and prostatic incision . A total of 80 patients suffering from symptomatic BPH in our center were r and omized for the four procedures as follow : ITT ( 18 ) : sidefocus technique ( 21 ) , incision ( 20 ) and TURP ( 21 ) . Inclusion criteria were at least 50 years old , prostate between 20 and 60 g , maximum peak-flow < or = 12 ml/s , and I-PSS > or = 15 . The patient 's pretreatment evaluation consisted in World Health Organization symptom score and quality of life , digital rectal examination , transrectal , ultrasound , PSA , urine culture , prostatic biopsy if malignity suspected , uroflowmetric parameters and residual volume . Follow-up was performed using the same pretreatment parameters at one month , three months and six months . Statistical analysis was performed using ANOVA test and Student-Newman-Keul test . Symptom score decreased significantly in all groups . Peak flow rate increase was observed in the four groups but without statistical significance in both laser techniques . Results at the sixth month control comparing peak-flow rates are significantly more favourable for endoscopic surgical techniques ( TURP and incision ) . Other flowmetric parameters , days of hospital stay , duration of catheter drainage , symptom scores and morbidity are analyzed The aim of this study was to prospect ively evaluate the safety and efficacy of contact laser ablation of the prostate ( CLAP ) vs. transurethral resection of the prostate ( TURP ) in symptomatic benign prostatic hypertrophy ( BPH ) . During a 1-year period ( 1995 - 1996 ) , 37 males 50 years of age or older were r and omized to either CLAP using Nd : YAG laser treatment or TURP .  Patients with Qmax < 15 mL/s , American Urological Association ( AUA ) symptom score > 12 , and postvoid residual ( PVR ) > 125 mL were enrolled . Patients were excluded if they had prior surgical treatment for BPH or known conditions that could affect bladder function . Comparisons of preoperative and postoperative symptom scores , Qmax , PVR , total catheter time , hospital stay , complications , and hematocrit changes were performed . A 2:1 r and omization was used , which result ed in 26 CLAP and 12 TURP patients . One-year follow-up data were available for 21 CLAP and 7 TURP patients . The mean prostate volume , age , AUA symptom score , and Qmax were not significantly different between the two arms . Significant differences in favor of CLAP were shorter catheter time ( 27.2 vs. 40.4 hours ; p < .05 ) and shorter hospital stays ( 28.5 vs. 60.0 hours ; p < .05 ) . The only other significant difference between the two arms was a lower AUA symptom score in favor of TURP at 1 year ( 4.7 vs. 8.4 ; p < .05 ) . Qmax , PVR , and postoperative hematocrit were similar between the groups . The only complications included recatheterizations , which occurred more frequently in the TURP patients ( 25 % vs. 14 % ) . CLAP appears to be slightly less effective in AUA symptom score reduction ; however , it is equally safe and is superior for shortening catheter time and hospital stay compared to TURP PURPOSE There are 2 main medical preparations available for lower urinary tract symptoms result ing from benign prostatic hyperplasia ( BPH ) . Choosing between an alpha-blocker and a 5alpha-reductase inhibitor requires trade-offs between their attributes or characteristics . We investigated the relative importance of and trade-offs between the attributes of the 5alpha-reductase inhibitor dutasteride and alpha-blockers in community dwelling men using a vali date d technique . MATERIAL S AND METHODS A discrete choice experiment was administered to 211 men older than 40 years who were r and omly selected from the general United Kingdom population . Attributes investigated in the discrete choice experiment were time to symptom improvement , sexual and nonsexual side effects , the risks of acute urinary retention ( AUR ) and surgery , cost and prostate size decrease . Using regression analysis the relative importance of these attributes , the trade-offs that men are willing to make between these attributes and the willingness to pay for each attribute were estimated . RESULTS All attributes were important to respondents . The most important attribute was side effects . The least preferred side effects was impotence , followed by decreased libido and dizziness . Respondents were willing to wait 13 , 2 and 8 months longer for symptom improvement in exchange for decreased prostate size , and the risks of AUR and surgery , respectively . Men reporting moderate symptoms were less concerned about sexual side effects , time to symptom improvement and the risk of AUR compared with men reporting mild symptoms . CONCLUSIONS Given the attribute levels of BPH medical treatment , overall community dwelling men preferred the 5alpha-reductase inhibitor over alpha-blockers . In the interests of shared decision making it is important to consider the importance of eliciting the preferences of patients with BPH PURPOSE Care for men with benign prostatic hyperplasia consumes a sizable amount of health care re sources , which is largely driven by bother from lower urinary tract symptoms . While cross-sectional studies have demonstrated a strong correlation between frequency of symptoms and associated bother , there are few longitudinal data demonstrating how these track together . MATERIAL S AND METHODS In 1989 , 2,115 white men between 40 and 79 years old were recruited from a r and om sample of the Olmsted County population . These men completed a self-administered question naire that assessed lower urinary tract symptom severity and associated bother with questions similar to those in the American Urological Association Symptom Index . Question naires were completed biennially thereafter through 1996 . RESULTS Annualized changes in symptom score increased from a median of 0.02 per year ( 25th , 75th percentile -0.35 , 0.60 ) for men in their forties to 0.43 ( -0.12 , 1.16 ) for men in their sixties . The median change in bother scores was 0 ( -0.30 , 0.29 ) across all ages . The correlation between longitudinal symptom score slopes and bother score slopes was 0.55 ( p < 0.001 ) overall and did not differ substantively across age . CONCLUSIONS These results demonstrate that there is a great deal of variability between individuals in the amount of longitudinal change in lower urinary tract symptom severity and bother . While for bother , there is little change across individuals on average , within individual frequency and bother track together fairly closely . However , there remain some men with increases in frequency who do not report similar increases in bother , possibly representing some component of adaptation or acceptance of worsening symptom severity with age OBJECTIVES To evaluate longer term effects of transurethral resection ( TURP ) and incision ( TUIP ) of the prostate in r and omized patients . METHODS In a r and omized , prospect i ve study , 120 patients with symptoms of bladder outlet obstruction caused by smaller benign prostates ( estimated resectable weight less than 20 g ) were assigned to TURP or TUIP . Patients were evaluated preoperatively and at intervals postoperatively as to urinary symptoms ( Madsen 's question naire ) , sexual function , and uroflowmetry . Overall evaluation of outcome of surgery was also assessed at follow-up visits . RESULTS Fifty-six patients received a TURP and 61 a TUIP . Three patients refused to participate in the project after r and omization , and 5 patients were lost to or excluded from follow-up . A group of 112 patients were obtainable for postoperative evaluation with a mean follow-up time of 34 months ( 1 to 82 months ) . Improvements in mean urinary peak flow rates were seen in both groups throughout the study period . The peak flow rates generally were higher ( but not statistically so ) in the TURP group . Postoperative irritative , obstructive , as well as total symptom scores decreased significantly at all follow-up visits after both TURP and TUIP ( P < or = 0.034 ) . Preoperatively and at all postoperative follow-up there was no statistically significant difference in irritative , obstructive , or total symptom scores between TURP and TUIP . The patients indicated an overall subjective improvement at all follow-ups in both groups , with no statistically significant difference between the treatment groups . Fifteen of 22 ( 68 % ) patients receiving TURP and 8 of 23 ( 35 % ) in the TUIP group who were sexually active before and after surgery developed postoperative retro grade ejaculation ( P = 0.020 ) . Postoperatively , 9 ( 16 % ) of the patients in the TURP and 14 ( 23 % ) in the TUIP group received further treatment for benign prostatic hyperplasia (BPH)-related infravesical obstruction . This difference was not statistically significant ( P = 0.908 ) . CONCLUSIONS In small prostates TURP and TUIP were generally equally effective in relieving bladder outlet obstruction secondary to BPH . Most surgically treated BPH cases can be well managed by the incision technique , which is an underutilized procedure Transurethral resection of the prostate and bladder neck incision are accepted methods in the treatment of obstructive prostatic hyperplasia . Bladder neck incision is particularly useful in cases of small prostates . We have modified the method of bladder neck incision to bladder neck resection . A r and omized prospect i ve trial was done to compare the results of conventional transurethral resection of the prostate ( 30 patients ) and the new method of bladder neck resection . Bladder neck resection was comparable to transurethral resection of the prostate with respect to postoperative hospital stay , maximal flow rates and postoperative complications .  Bladder neck resection was better than transurethral resection with respect to the operating time , transfusion requirement , volume of irrigation fluid and postoperative urinary infection . We conclude that bladder neck resection is the operation of choice in patients with a prostate of 30 gm . or less One hundred patients with benign prostatic hypertrophy ( BPH ) were r and omized  to transurethral incision ( TUIP ) or transurethral resection of the prostate ( TURP ) . The average prostate weight before operation was not more than 30.0 g. Indications for the operations were based on the disease history , physical examination , digital rectal examination , laboratory values , and pressure-flow examination . All operations were performed with patients under spinal anesthesia . TUIP was performed with a Collins knife , and TURP was performed with a resectoscope . Follow-up was performed 24 months after the operations . After treatment there were statistically significant daytime and nocturnal reduction in voiding frequencies of 2.9 and 1.7 , respectively , after TUIP , and 2.0 and 1.5 after TURP . In both groups , there occurred significantly better maximal flow rate from 7.6 mL/s to 16.9 mL/s in group I and from 6.9 mL/s to 17.6 mL/s in group II . The mean values of linearized passive urethral resistance relation in both groups significantly decreased from 3.6 + /- 0.6 to 1.0 + /- 0.5 after TUIP and from 3.9 
    Output:
    
No difference in the degree of symptomatic improvement was seen between the two procedures .
Improvement in peak urine flow rate was lower for TUIP compared to TURP whilst the rate of blood transfusion and TUR syndrome was higher after TURP .
Urinary retention , urinary tract infection , strictures and incontinence did not differ between the two approaches , although clinical ly important differences could not be ruled-out .
TUIP was associated with a shorter duration of operation and length of hospital stay but a higher re-operation rate .
Conclusion TUIP and TURP appear to offer equivalent symptomatic improvement for men with mild to moderate BPE .
Choosing TUIP involves a trade-off between the lower risk of peri-operative morbidity and the higher risk of subsequent re-operation