In this study we designed a procedure specifically for the treatment of small volume BPH, STRUP+TUIBN, to improve the effectiveness of treating small volume BPH, and at the same time reduce the incidence of intra- and postoperative complications. The results showed that the IPSS in patients receiving STRUP+TUIBN was markedly higher than that in patients receiving TURP while STRUP+TUIBN was comparable to TURP in operation time, volume of blood loss, and resected prostate gland mass.
BPH is prevalent among elderly men, and is found in 40% of men aged 60 years and above and 80% of men aged 80 years and above. The enlarged prostate compresses against the urinary tract and contributes to urinary tract infections and increases the likelihood of urolithiasis. Long term urinary tract obstruction causes hydronephrosis, which can ultimately lead to renal failure and even death. Surgical therapy is recommended for those who have failed conservative therapy. Currently, TURP is the primary surgical treatment for BPH 
. For some BPH patients, however, the outcome of TURP is not sufficient, especially those with small volume BPH. While studies have examined the use of conventional BPH treatments for patients with small volume BPH, there have been no treatments developed that are specifically designed for small volume BPH.
Prostate enlargement causes mechanical and dynamic obstruction in both small volume and large volume BPH. In a urodynamic study of 63 BPH patients, Yang et al. 
found that prostate mass correlates with BOO in patients with a prostate mass ≥30 g; however, this correlation was not seen in patients with a prostate mass <30 g, suggesting that apart from prostate enlargement, other factors also contribute to BOO. These factors may play insignificant roles in large volume BPH, but marked roles in small volume BPH. Bladder neck contracture due to fibrosis, increased tension from circular fibers in the bladder neck, and chronic prostatitis are common physiopathological causes of small volume BPH 
. Medical therapy with α1-adrenergic receptor blockers and 5-α reductase inhibitors. cannot address all the root causes of small volume BPH, and fails to deliver desirable outcomes in some of these patients for whom surgical treatment for BOO remains a viable option.
While TURP is the most commonly used surgical treatment for BPH, the compression by the enlarged prostate in small volume BPH does not play a predominant role in BOO. Even if adequate resection of prostate tissue is accomplished, improvement in BOO is limited. In addition, simple TURP does not address the issues of bladder neck contracture due to fibrosis, increased tension from circular fibers in the bladder neck, and chronic prostatitis, which are common physiopathological causes of small volume BPH 
. TURP may also inadvertently aggravate postoperative bladder neck contracture due to the thermal effect on bladder neck tissue by intraoperative hemostasis and the resection of bladder neck tissue 
. In the current study, bladder neck contracture was seen in 3 patients (4.92%, 3/61) undergoing simple TURP, which is consistent with the literature 
To avoid the above issues associated with TURP for small volume BPH, we designed STURP, which have several advantages over TURP. First, STURP selectively preserves partial epithelia in the anterior wall of the urinary tract, which increases epithelialization of the urinary tract after surgical trauma, thus minimizing irritation of the surgical wound by urine and reducing scar formation. Second, apart from resection of prostate tissue, STURP effectively relieves bladder neck contracture and lowers bladder neck tension, thereby alleviating BOO, and also avoids the possibility of incisional adhesions from excessive residual gland tissue in transurethral incision of the prostate (TUIP). Third, STURP preserves the original fibrous tissue between the 2 incisions in the bladder neck and avoids fibrosis of the preserved tissue, further reducing the possibility of bladder neck contracture due to excessive scar formation.
In our follow-up of small volume BPH patients, we found that the IPSS in patients receiving STURP was markedly higher than that in patients receiving TURP while STURP was comparable to TURP in operation time, volume of blood loss, and resected prostate gland mass, suggesting that STURP may offer a more effective treatment for small volume BPH without an increase in operative parameters. Given the limited number of patients and length of follow up in this study, the efficacy of STURP for small volume BPH needs to be confirmed by future prospective controlled studies involving a greater number of small volume BPH patients with longer follow-up. STURP is simple to learn and easy to perform, and we believe that STURP may offer a more effective and safer alternative to TURP for small volume BPH patients.