Transurethral resection versus minimally invasive treatments of benign prostatic hyperplasia: results of treatments. Our experience.
OBJECTIVE
In this non-randomized prospective study the results of standard TURP (Transurethral Resection of the Prostate) versus other minimally invasive treatments were compared.


METHODS
Among all the patients treated at our Institution for bladder outlet obstruction due to BPH (Benign Prostatic Hyperplasia) from January 1995 to June 1998, 212 patients have been evaluated; 90 patients underwent to TURP, 13 patients to TVP (Transurethral ElectroVaporization), 24 patients to TUNA (TransUrethral Needle Ablation), 71 patients to ILC (Interstitial Laser Coagulation), and 13 patients to WIT (Water-Induced Thermotherapy).


RESULTS
TURP achieves the highest decrease of prostate volume (48.8%), the best increase of maximum flow rate (75.3%) and the highest decrease of residual volume (89.8%) in comparison to other methods; these results are substantially stable 24 months after treatment; on the other hand, after WIT a reduction of prostatic volume of 5.2%, an increase of maximum flow rate of 16.7% and a decrease of residual volume of 25.2% can be observed. The relief of bladder outlet obstruction is indicated by the decrease of detrusor pressure at maximum flow rate in comparison to baseline values; it decreases of 27.5% for WIT, of 34.8% for TUNA, of 38.3% for ILC, of 48.4% for TUR, and of 53.3% for T.P The recorded results are substantially stable 24 months after treatment. A marked decrease of IPSS and QL score can be observed for all the procedures after 6 months, ranging from 40.2% for WIT to 76.7% for TUNA; however, these parameters undergo to a slight worsening 24 months after treatment for TURP, TVP and TUNA, while remain substantially stable for ILC and WIT.


CONCLUSIONS
From the analysis of our results, it appears that TURP is still the golden standard treatment for BPH; TURP remains the most effective and definitive way of treatment, but it could be less attractive from the patients' perspective, especially after minimally invasive treatments with good tolerability have become available. It is therefore evident that the choice of each method should be performed in consideration of patients' general performance status, of symptoms and of indications and contraindications of each method.
Minardi
Daniele
D
Institute of Urology, Polytechnic University of the Marche Region, Medical School, Ancona, Italy. d.minardi@univpm.it
Galosi
Andrea Benedetto
AB
Yehia
Mamhoud
M
Cristalli
Alfonso
A
Hanitzsch
Herbert
H
Polito
Massimo
M
Muzzonigro
Giovanni
G
D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D006979:Hyperthermia, Induced; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D011470:Prostatic Hyperplasia / Q000601:surgery* / Q000628:therapy; D020728:Transurethral Resection of Prostate