Surgical treatments for benign prostatic hyperplasia
| Transurethral resection of prostate (TURP) | Transurethral microwave therapy | Photovaporization of prostate | Simple prostatectomy | |
|---|---|---|---|---|
| Technique description | Endoscopic resection of the prostate under direct visualization using monopolar or bipolar loop electrocautery | Ablation of the prostate using a specialized catheter with a microwave antenna | Endoscopic vaporization of the prostate using high-powered laser energy | Surgical removal of prostatic tissue using an open, laparoscopic, or robotic approach |
| Anesthesia | Spinal or general | Local | Spinal or general | Spinal or general |
| Typical postoperative catheterization | 24–48 hours (longer if hematuria) | Several days | < 24 hours | Several days |
| Common complications | Retrograde ejaculation Blood loss anemia Urinary tract infection Urinary retention Bladder neck contracture | Urinary retention Urinary tract infection Retrograde ejaculation | Irritative urinary symptoms Hematuria Urinary tract infection | Hematuria Blood loss anemia Urinary tract infection |
| Advantages | Gold standard Mean 70% reduction in International Prostate Symptom Score (IPSS) and mean 12-mL/sec improvement in peak urinary flow 1 year after surgery | Office procedure Same-day discharge | Safe to perform while on antiplatelet therapy Can typically remove catheter and discharge home on day of surgery Similar improvement in peak urinary flow and IPSS relative to TURP | Excellent option for men with prostates > 75 g Allows concurrent treatment of bladder diverticula or stones Reduced morbidity with robotic approach Similar improvement in peak urinary flow and IPSS relative to TURP |
| Disadvantages | Higher risk of hematuria than other surgical options Often requires postoperative hospitalization | Less durable results, high rate of retreatment Less symptom improvement than with other surgical therapies Higher incidence of urinary retention requiring prolonged catheterization Not available in all urology practices | Requires long operative time for large prostate volumes | More invasive procedure with longer convalescence Urologists experienced in this procedure not available in all practices High rate of blood transfusion (lower risk with robotic approach) Requires postoperative hospitalization |
Information from reference 50.