Surgical and Minimally Invasive Interventions for LUTS/BPH: Highlights from 2006

ObjectivesThis manuscript reviews the strengths and weaknesses of alternatives to transurethral resection of the prostate (TURP) to treat lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).MethodsThe majority of data discussed in this paper were presented at the 2006 annual meetings of the European Association of Urology and the American Urological Association. Data from randomised controlled trials (RCTs) comparing surgical interventions for LUTS/BPH versus TURP, from studies including >100 patients and with at least 1 yr of follow-up were included. The participants’ opinions on two representative clinical cases were assessed via interactive voting.ResultsShort-term efficacy of therapy analogues to TURP (bipolar transurethral resection in saline [TURIS], transurethral vaporisation of the prostate [TUVP], and holmium laser resection/enucleation [HoLRP/HoLEP]) seems comparable to TURP, with good safety profiles. Various direct comparative studies show that energy-based ablative techniques (transurethral needle ablation [TUNA], transurethral microwave therapy [TUMT], and photoselective vaporisation of the prostate [PVP]) may be an effective alternative to TURP and are associated with fewer complications. Mechanical stenting seems to be a solution for patients who cannot undergo general anaesthesia. Initial data on the use of botulinum toxin for LUTS/BPH looks promising. However, in all cases, more long-term data (>5 yr of follow-up) are needed to confirm these short-term outcomes.ConclusionsAccumulating evidence is reported in favour of several alternatives to TURP. However, in all cases, prospective, long-term RCTs are needed to evaluate if these promising short-term outcomes are sustained over time.