Minimally invasive surgery for benign prostatic hyperplasia--a review.

Abstract

A whole range of new therapies for benign prostatic hyperplasia (BPH) is now being developed and evaluated. The traditional treatments for the benign enlarge and obstructing prostate, including open prostatectomy and more recently, transurethral resection of the prostate (TURP), are discussed, laying the groundwork for a detailed discussion of the different new minimally invasive modalities. These new modalities are discussed in three sections: modifications of TURP, non-ablative minimally invasive procedures and ablative minimally invasive procedures. Medications are not discussed. TURP remains predominant in the treatment of the obstructing benign prostate, but modalities like stents, microwave or radiofrequency or focused ultrasound-induced prostate thermotherapy as well as laser prostatectomy in its various forms and modifications may provide a wide selection for the urologist today. Although none of these have improved the effectiveness of TURP, the rates of morbidity in some are better, extending the limits of treatment. Costs too are a concern with some of these modalities being prohibitively expensive, whilst in others, savings in hospital stay and lesser morbidity may outweigh an expensive initial outlay. Many of these treatments are still evolving and well-constructed, prospective, randomised and long-term trials are required. Until one or more of these new treatments improve much further, TURP will remain the mainstay of BPH treatment.