Transurethral prostatectomy (TURP): still the gold standard?
1. The indication for treating BPH can be established very precisely today. It is important to select the alternative procedures with a good workup for individual therapy. 2. A large volume prostate with proven obstruction is an indication for TURP or open prostatectomy, still the best choice of treatment with the best longterm results concerning all obstructive parameters. In future there may be less surgery due to the other possibilities but teaching and handling the gold standard should not be forgotten in using alternative techniques. 3. Especially for high risk patients there are minimal invasive methods so that a permanent catheter in a patient should be an exception. 4. Also with new medications we expect better results. Prostate selective alpha-blockers and reduction inhibitors probably also in combination of both may be sufficient therapy for many patients. It has to be examined whether minimal invasive instrumental treatments like transurethral thermotherapy can be compared with medication. The most important result of the discussion in the last years was improving the clinical workup for finding the indication for surgery. Too many new instrumental methods appeared at the same time and we are in a period of selection and investigation to know which technique can be compared with the gold standard of TURP. Also in using minimal invasive therapy the indication must be very clear because also the new techniques are not totally free from complications.
Hartung
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D002404:Catheterization / Q000379:methods; D006801:Humans; D017075:Laser Coagulation / Q000379:methods; D053685:Laser Therapy / Q000379:methods; D008297:Male; D011468:Prostatectomy / Q000379:methods*; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015607:Stents; D014463:Ultrasonography