[Surgical treatment of benign prostatic hyperplasia-resection, vaporization or enucleation?] / Operative Therapie des benignen Prostatasyndroms ­ resezieren, vaporisieren oder enukleieren?

ABSTRACT

BACKGROUND: Benign prostatic hyperplasia (BPH) is the most common condition affecting the male lower urinary tract. Besides transurethral resection of the prostate (TURP), vaporization of the prostate and endoscopic enucleation of the prostate are available. OBJECTIVES: To provide an overview of the current status of surgical therapies for BPH. MATERIALS AND METHODS: Narrative review of the literature on the surgical treatment of BPH. RESULTS: Besides TURP, which still can be regarded as the reference technique for surgical treatment of BPH in men with a prostate volume <80 cc, greenlight laser vaporization of the prostate (GLV) and endoscopic enucleation of the prostate (EEP) are established and evidence-based alternatives. A multitude of prospective randomized trials could show comparable functional outcomes of GLV or EEP in comparison to TURP. Based on lower comorbidity and comparable outcomes, bipolar TURP rather than monopolar TURP should be regarded as the surgical reference technique. In patients with ongoing oral anticoagulation of thrombocyte aggregation inhibition, GLV provides high intra- und postoperative safety. Endoscopic enucleation of the prostate is the only transurethral surgical method which provides high level evidence concerning safety and efficacy in patients with prostates >80 cc. CONCLUSIONS: Choice of surgical treatment of BPH should be individualized and based on prostate size, comorbidities and surgical experience.