Article Figures & Data
Tables
- TABLE 1
Office-based procedures for benign prostatic hyperplasia, compared with transurethral resection
Treatment Transurethral resection of the prostate Prostatic urethral lift procedure Water vapor thermal therapy Temporarily inserted nitinol device Surgery type Cystoscopic electric excision Cystoscopic placement of sutures to open the urethra Cystoscopic application of steam to ablate the prostate Cystoscopic placement of a temporary urethral stent Operative setting Operating room Office Office Office Anesthesia General or spinal Local, sometimes with sedation Local, sometimes with sedation Local, sometimes with sedation Ideal prostate size ≤ 80 cc (sometimes a bit larger) ≤ 80 cc with no median lobe enlargement ≤ 80 cc (sometimes a bit larger) < 75 cc, with no median lobe enlargement Contraindications Anticoagulation
Elevated bleeding risk
Narrow urethraLarge median lobe
High bladder neck
Allergy to implantFibrotic gland (due to prior procedure for prostatic hyperplasia or radiation) Large median lobe
Larger gland
Fibrotic glandAdvantages Historical gold standard
Widely accessiblePreserves sexual function Preserves sexual function Preserves sexual function Postoperative catheter time 1–3 days None (some cases) 3–7 days None Durability Good Poor Good Unknown Erectile dysfunction Uncommon None None None Unique complications Electrolyte abnormalities (transurethral resection syndrome) Expected retreatment
Bladder stonesTransient retention from prostate edema Dislodgement or migration - TABLE 2
Operating-room-based surgeries other than transurethral resection for benign prostatic hyperplasia
Treatment Photoselective vaporization of prostate Holmium laser enucleation of the prostate Simple prostatectomy Robotically controlled water jet treatment Surgery type Cystoscopic laser vaporization Cystoscopic laser excision Abdominal excision Cystoscopic water jet ablation Operative setting Operating room Operating room Operating room Operating room Anesthesia General or spinal General or spinal General or spinal General or spinal Ideal prostate size ≤ 100 cc (sometimes a bit larger) ≤ 250 cc > 80 cc, with or without concomitant pathology, eg, bladder calculi, diverticula ≤ 150 cc Contraindications Prior radiation (Not available) Anticoagulation
Elevated bleeding riskAnticoagulation
Elevated bleeding riskAdvantages Excellent hemostasis
Small caliber scopeSize-independent
Durable resultsDone under vision (robotic)
Durable resultsPreserves sexual function Postoperative catheter time 1 day 1 day 5–10 days 1–5 days Durability Good Excellent Excellent Unknown Erectile dysfunction Rare Uncommon Uncommon None Unique complications Obstruction from sloughed tissue passage Bladder injury from morcellator Risks of surgical incision
Risks of intra-abdominal surgeryUnknown
