Transurethral Resection of the Prostate

For decades, transurethral resection of the prostate (TURP) has been the gold-standard therapy for severe benign prostatic obstruction (BPO). Diagnostic work-up and indications for TURP should follow the European Association of Urology benign prostatic hyperplasia guidelines. Pressure flow studies are not indicated as a routine diagnostic procedure but are highly recommended under certain conditions (eg, unsuccessful TURP, young age, previous pelvic surgery). Various technical improvements such as video-TURP, continuous-flow instruments, and bipolar TURP have substantially decreased the mortality and morbidity of TURP today. In the bipolar transurethral resection era, bleeding remains the most significant intra- and perioperative complication. The short-term and, particularly, long-term efficacy of TURP is unsurpassed, as documented by substantial improvements in symptoms, maximum flow rate, and postvoid residual volume. The retreatment rate of TURP is in the range of 8–12% within a decade after primary surgery, a value reached by many minimally invasive procedures as early as within 1–2 yr. Despite an intense 20 yr of research for a minimally invasive alternative, TURP still is and will most likely remain the reference standard for the surgical management of severe BPO.