Surgical management for benign prostatic hyperplasia: indications, techniques, and results

Abstract

Diagnostic possibilities have improved with urodynamic studies and rectal ultrasound. Many more patients with benign prostatic hyperplasia (BPH) need urodynamic investigation because 25% of men with symptoms have no prostatic obstruction. Ultrasound is quite accurate in choosing the proper surgical technique. Open prostatectomy has largely been replaced by transurethral prostate resection (TURP). One reason is better surgical equipment, but another is that patients come earlier with smaller prostates. For obstructive prostates less than 20 g, transurethral incision (TUI) of the prostate is indicated. The results are as good as those of TURP. Primary success rates for TURP, TUI, and open prostatectomy are good, but in long-term follow-up studies, 10-25% of the patients have secondary procedures after 5-10 years.