New surgical treatment options in patients with benign prostate hyperplasia (BPH)

Abstract

Benign prostatic hyperplasia (BPH) is a common disease in males older than 50 years of age. 75-80% of this population is considered to have some degree of BPH causing clinical symptoms and requiring urological treatment. Transurethral resection of the prostate (TUR-P) is currently the standard surgical treatment modality for BPH. In an attempt to minimize the need for hospitalization and the associated perioperative and postoperative morbidity, alternatives have been sought. Various types of Laser techniques such as interstitial Laser coagulation and side-firing technology have been proposed. Numerous studies have shown that Laser procedures safely and effectively reduce the volume of the prostate. Intra-and postoperative bleeding are nearly unknown complications for Laser procedures, whereas this is the most relevant complication for the TUR-P. Due to significant tissue edema after Laser treatment, patients commonly show delayed time to void adequately and, therefore, catheter drainage is often necessary for 3 to 21 days. Retrograde ejaculation is reported to occur less (0-10%) compared to TUR-P (> 60%). Urinary tract infections are very common after interstitial laser coagulation. Although not many long-term clinical data are available, various studies have shown that BPH patients improve in symptom score, flow rate and post-void residual up to 3 years after Laser treatment. This paper presents a concise review of efficacy, advantages and disadvantages of the most frequently used Laser techniques as well as the long-term clinical data compared to TUR-P.