The Current Role of Open Surgery in BPH

ObjectiveOpen prostatectomy has been one of the distinctive features of our specialty and the gold standard treatment of benign prostatic hyperplasia (BPH) for over 50 years. The operation is almost abandoned in some western countries although it is still relatively commonly performed in others. This article reviews the evidence for open prostatectomy and discusses its current role in our daily practise and postgraduate training programmes in urology.Materials and methodsWe have searched the Medline database for open prostatectomy, reviewed all the reported references, obtained all full text articles we could retrieve from our and other libraries. We have read a number of old full text articles dating before 1964 which were quoted in more recent papers. We have read the relevant chapters of most books on the management of BPH.ResultsOpen prostatectomy maintains an outstanding clinical outcome. The procedure has the lowest failure rate amongst the different operations but carries also the highest morbidity rate, the largest patient burden and costs. The decreasing number of cases performed in most urological centres will make it difficult to maintain open prostatectomy in the core curriculum of postgraduate training programmes in urology. The procedure will certainly continue to have a role in less developed countries where BPH surgery is mostly performed by general surgeons.ConclusionOpen prostatectomy served us well for over a century but its role in the urologists’ armamentarium is declining. When the current generation will retire the expertise may be lost in some countries of the western world. It is imperative that our skill is passed over our colleagues operating in less wealthy areas of the world where the procedure can still save lives and improve patients’ quality of life.