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Table 1.  

Prospective, Randomized Trials That Compare Monopolar TURP With Bipolar TURP

Table 2.  

Prospective, Randomized Trials That Compare Monopolar TURP to Various Laser Procedures

Box 1.  

Indications for Surgical Intervention for Benign Prostatic Hyperplasia

Surgical Management of Benign Prostatic Hyperplasia: Current Evidence

Authors: Abdulaziz Baazeem, MD; Mostafa M. Elhilali, MD, PhD, FRCSCFaculty and Disclosures

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Summary and Introduction

Summary

Benign prostatic hyperplasia (BPH) is one of the most common male urological disorders. The surgical management of BPH is evolving at a rapid rate, with several new procedures available that challenge transurethral resection of the prostate as the standard treatment in the surgical management of small to medium sized glands. The new procedures aim to achieve results comparable to transurethral resection of the prostate while minimizing morbidity and cost. In this Review, we discuss some of the current surgical options for the treatment of BPH that seem popular in the literature.

Introduction

Benign prostatic hyperplasia (BPH) is a common urological disorder. One population-based study, published in 2001, suggests that it might affect up to 8.4% of men aged 40-49 years and 33.5% of those aged 60-70 years ( Box 1 ).[1] In the 20th century, open surgical management of BPH became popular. A relatively high-morbidity and expensive procedure, open prostatectomy was gradually replaced by transurethral resection of the prostate (TURP) as the standard surgical treatment of small to medium sized BPH. High success rates, lower costs and shorter recovery times after TURP were among the factors contributing to the gradual replacement of open prostatectomy; however, TURP is associated with considerable complications, including the need for blood transfusions in 2.0-4.8% of patients and the occurrence of transurethral resection (TUR) syndrome in 0-1.1% of patients.[2] Eight-year follow-up data on a large cohort of 23,123 men who underwent TURP showed a cumulative incidence of repeat endourological interventions of 14.7%.[3] The incidence of TUR syndrome increases with a gland size greater than 45 g and resection times longer than 90 min.[4]

Over the past 15 years, numerous alternative procedures have been introduced with the goal of achieving comparable results to TURP, while minimizing morbidity and cost. Many of these alternative procedures have not fulfilled these objectives, while a few maintain the potential to replace TURP owing to the promising results from several methodologically sound, prospective, randomized controlled trials. In this Review, we examine the most commonly discussed surgical procedures, among the current literature, that are used to treat BPH, with special emphasis on original research.

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