Reviewing the surgical management of benign prostatic hyperplasia

This study reviewed the surgical management of benign prostatic hyperplasia (BPH).  

Benign prostatic hyperplasia (BPH) is a condition in which the prostate grows larger than normal. The prostate can then squeeze the urethra (the tube that drains the bladder) causing problems with urination.

Medical treatments may not be effective in many patients with BPH or may cause significant side effects that may limit their use. BPH can be treated using a number of surgical procedures to reduce the size of the prostate or to remove portions of the prostate blocking urine flow. It is not clear which procedure is best or what factors should be considered when choosing a treatment.

This study looked at previous studies involving surgical procedures used to treat BPH. 

A number of factors should be considered when choosing a surgical treatment, including the size of the prostate and whether BPH is causing any damage to the kidneys.

It is recommended that imaging tests such as ultrasound, cystoscopy, or MRI/CT should be performed before choosing a surgical treatment. These can evaluate the size and shape of the prostate. The urine volume remaining in the bladder after urination (post-void residual or PVR) should also be assessed. Patients should be informed that not all treatments are effective for all patients and that the risk of needing another procedure exists. 

Surgical treatments are particularly recommended for patients with kidney problems due to BPH, with recurrent urinary infections or kidney stones. The standard surgical procedure recommended for BPH is transurethral resection of the prostate (TURP; cutting away a portion of the prostate through the urethra). In patients with large or very large prostates, open or laparoscopic (keyhole) removal of the prostate (prostatectomy) can also be considered.

In patients with small prostates (below 30 cc), transurethral incision of the prostate (TUIP; the surgeon makes one or two small cuts in the area where the prostate connects to the bladder to reduce the pressure on the urethra) can be recommended.

In patients with urinary symptoms from BPH, laser procedures such as transurethral vaporization of the prostate (TVP) or photoselective vaporization of the prostate (PVP) or transurethral microwave therapy (TUMT; uses microwaves to remove excess prostate tissue) are recommended. 

In patients who desire a good sexual function, prostatic urethral lift (PUL) or water vapor thermal therapy (WVTT) is recommended. PUL uses an implant that separates the two lobes of the prostate to relieve pressure on the urethra. WVTT uses steam to remove excess prostate tissue. 

In patients with medium prostate sizes (30-80 cc), the recommended procedures are laser enucleation (HoLEP or ThuLEP), WVTT, and PUL. Another treatment option for these patients is robotic waterjet treatment (uses high-pressure saline to remove excess prostate tissue).

The choice of these treatments depends on the size and shape of the prostate, the surgeon's experience, cost, and patient preference. 

This article reviewed current surgical methods for BPH. Their choice depends on prostate size and shape, surgeon experience, patient preference, costs.