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Transurethral procedures for treating benign prostatic hyperplasia

Authors
Glenn R Cunningham, MD
Dov Kadmon, MD
Section Editors
Michael P O'Leary, MD, MPH
Jerome P Richie, MD, FACS
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Benign prostatic hyperplasia (BPH) becomes increasingly common as men age. Men with clinically significant lower urinary tract symptoms (LUTS) suggestive of BPH who do not find adequate relief with medical treatment may benefit from transurethral resection or ablation to enlarge the urethral channel to reduce the amount of prostate tissue around the urethra. Most procedures are performed via the urethra (ie, transurethral) using a cystoscope. Transurethral resection of the prostate (TURP) has been the main form of treatment for many years in men with BPH, and remains the standard against which other treatments should be compared. Most men who undergo TURP experience a marked decrease in urinary symptom scores, and a substantial increase in maximal urinary flow rates. However, the complications and cost associated with TURP have encouraged development of several alternative methods to remove or destroy prostatic tissue using a variety of energy sources.

Transurethral procedures for resection or ablation of prostate tissue, and other therapies for the treatment of BPH will be reviewed here. The clinical manifestations and management of BPH are reviewed elsewhere. (See "Clinical manifestations and diagnostic evaluation of benign prostatic hyperplasia" and "Medical treatment of benign prostatic hyperplasia".)

INDICATIONS FOR TREATMENT

Benign prostate enlargement is the physical enlargement of the prostate gland that is due to histologic changes known as benign prostatic hyperplasia (BPH). (See "Epidemiology and pathogenesis of benign prostatic hyperplasia".)

Bladder outlet obstruction due to BPH is frequently diagnosed clinically on the basis of lower urinary tract symptoms (LUTS) which can present acutely, or, more often, chronically. A decision to treat BPH is usually based upon the severity of symptoms determined by either the American Urological Association Symptom Index(AUA-SI) (table 1), or the International Prostate Symptom Score (I–PSS ) [1], which are very similar. In general, symptoms only require therapy if they have a significant impact on a patient's quality of life. Whether to proceed to surgical intervention is generally based upon the adequacy of medical therapy, the development of complications, and patient preference, rather than any specific urological parameter. The medical treatment of benign prostatic hypertrophy is discussed separately. (See "Medical treatment of benign prostatic hyperplasia".)

General indications for surgical intervention include:

                                   

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