Surgical treatment of prostatic hyperplasia.
BACKGROUND
For more than seven decades prostates have been enucleated surgically, and for almost six decades they have been resected endoscopically. Results have been impressive and increasingly better, and the procedure has been reasonably safe. Variations to these two approaches have abounded and have made it safer, quicker, and easier, but never cheaper.


METHODS
Currently, an abundance of alternatives have surfaced and for a variety of reasons. All alternatives share several shortcomings: results are not predictable, there is no tissue, and serendipitous prostate cancer could be missed. In addition, it may be categorically said that rarely does any of the alternatives achieve the effectiveness of prostatectomy that is appropriately indicated and properly performed.


RESULTS
Urologists should participate in an objective assessment of the comparative merits and deficiencies of the variations of and alternatives to prostatectomy. Assessment of outcomes, safety, efficacy, and cost, as well as the development of guidelines, should continue.


CONCLUSIONS
With our counsel and the government's reimbursement, the public will decide which alternatives are safe and reasonably effective and should survive.
Dowd
J B
JB
Lahey Clinic Medical Center, Department of Urology, Burlington, MA 01805.
D003710:Demography; D004724:Endoscopy; D005544:Forecasting; D006801:Humans; D008297:Male; D011468:Prostatectomy / Q000379:methods; D011470:Prostatic Hyperplasia / Q000601:surgery* / Q000628:therapy