Surgical and nonsurgical invasive treatment of benign prostatic hyperplasia

Abstract

A third era in the surgical treatment of benign prostatic hyperplasia (BPH) utilizes less invasive treatment modalities. Transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA) and a wide variety of laser treatments are the most conspicuous new treatment modalities approved or awaiting approval. In general, the alternative treatments produce less improvement in symptoms and peak urinary flow rates (Q(max)) than open prostatectomy or transurethral resection of the prostate (TURP), which remains the "gold standard". However, most are promising, particularly because they are associated with low morbidity. Long-term outcome has yet to be assessed with any of the newer treatments and total costs are difficult to calculate. Most have proved safe, are feasible on an outpatient basis and which, provided a low retreatment rate, will presumably reduce the socioeconomic costs. Although differences are found in outcome, morbidity and costs, none of the newer treatments has demonstrated convincing superiority or established a well-defined niche. In the future, controlled randomized studies against well-documented treatments like TURP or transurethral incision of the prostate (TUIP), focusing on long-term outcome, quality of life and socioeconomic costs, are needed.

The economics of medical therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia

“…TURP is more effective than medical therapy; nearly 90% of patients have symptom improvement at 1 year following TURP, with improvement in symptom scores (average 82%) and maximum flow rate (125%) [24]. TURP is more effective than medical therapy; nearly 90% of patients have symptom improvement at 1 year following TURP, with improvement in symptom scores (average 82%) and maximum flow rate (125%) [24].…”

Photoselective vaporization of the prostate. Review of cost implementation to BPH treatment

“…The 5-year estimated costs (1999 US $) were lower with a 1 -AR antagonist therapy ($6294) compared with those for TURP ($7334). 29 Another study in which medical therapy was compared to TURP, depicted that 5.5-10 and 7-15 years will elapse before the insurance (private or public) costs associated with finasteride and terazosin therapy, respectively, will surpass those for TURP. 17 Total costs for 2 years of treatment for each of the following alternatives: watchful waiting, finasteride, ablocker, TURP, and open prostatectomy, were compared in a study conducted by the AHCPR.…”

“…In addition, cost-effectiveness data have favoured the use of TUMT over TURP. 21,29,[32][33][34] In a prospective study in which patients were followed up for over a 2-year period, TUMT showed lower primary costs, lower complications but higher re-treatment costs compared with TURP. 24 On the other hand, using a Markov model, DiSantostefano et al examined the clinical and cost consequences over a 20-year period of watchful waiting (WW), pharmacotherapy, TUMT and TURP.…”

The economics of medical therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia

“…TURP is more effective than medical therapy; nearly 90% of patients have symptom improvement at 1 year following TURP, with improvement in symptom scores (average 82%) and maximum flow rate (125%) [24]. Refinements in the TURP procedure over the years have led to treatment failure rates of 10% or less after 3 years of follow-up [24]; complications such as stricture and bladder neck contraction may occur in approximately 4% of patients. However, being more effective does not necessarily mean lower overall costs.…”

“…MIT is more effective than medical therapy, but less effective than TURP in most BPH parameters [24]. Outpatient TUMT has significantly lower costs than TURP ($1345 vs $2558), as no hospital stay is required [26].…”