Is transurethral resection of the prostate still justified

TLDR: The objective of this review is to determine the current TUVP 4 27–30 199 189 status of TURP with particular reference to less invasive Holmium Laser procedures and recent developments of transurethral VLAP.

Abstract: (WW) to holmium-laser resection (Table 1). RCTs with Introduction a follow-up of <6 months and with a substantial number of patients in urinary retention preoperatively were For decades TURP was the undisputed gold standard of therapy for patients with LUTS due to BPH; however, excluded. within the past 10 years this role has increasingly been challenged by the development of medical (5a reductase The current morbidity of TURP inhibitors, a1-receptor blockers) and less invasive interventional alternatives [1–8]. The main driving forces Mortality after TURP has decreased substantially during the past 30 years and is <0.25% in contemporary TURP behind this development were the high prevalence of the disease, an absolute indication for surgery in only 5–10% series [10–16]. Horninger et al. reported no postoperative deaths in a consecutive series of 1211 patients underof patients with symptomatic BPH, recent technical innovations and, most importantly, the apparently going TURP between 1988 and 1991 [16]. In the 29 RCTs reviewed, no patient died within the first 6 weeks unchanged high morbidity of TURP [9–16]. As a result, the number of prostatectomies decreased substantially after surgery, reflecting advances in anaesthesia achieved during the past two decades. [17,18], e.g. in the USA the number of TURPs for BPH was 253 000 within the US Medicare Program in 1987 The major intraoperative complication of TURP and fell to 145 000 in 1994, a reduction of 43% [17]. This trend is also demonstrable in Europe, although less Table 1 Pertinent characteristics of the 29 RCTs analysed pronounced in countries with very extensive public healthcare systems [18]. Enthusiastic reports on the No. of patients* in success of alternative treatment options in the lay and No. of urological press seemed to herald the end of TURP as Method studies Reference(s) TURP Control the gold standard, perhaps best reflected by Stamey’s Open 1 20 43 32 quote in 1993 that ‘TURP is now a therapy of history’ Prostatectomy [19]. TUIP 6 21–26† 285 270 The objective of this review is to determine the current TUVP 4 27–30 199 189 status of TURP with particular reference to less invasive Holmium Laser 1 31 11 23 procedures and recent developments of transurethral VLAP 7 32–38 351 416 electrosurgery. To reliably assess this issue, we reviewed ILC 2 39, 40 41 60 the recent urological literature and, specifically, all 29 TUNA 2 41, 42 107 117 TUMT 2.5 2 43, 44 61 61 randomized clinical trials (RCTs) published between IRFT 1 45 25 25 1986 and 1998 comparing less-invasive treatment TUMT 2.0 1 46 32 37 options directly with TURP (Table 1) [20–48]. These 29 BDP 2 26†, 47 45 46 RCTs contain clinical information for a total of 3032 WW 1 48 280 276 patients, 1480 being randomized to TURP, 1552 to lessTotal 29 148