SURGICAL AND NONSURGICAL INVASIVE TREATMENT OF BENIGN PROSTATIC HYPERPLASIA

A third era in the surgical treatment of benign prostatic hyperplasia (BPH) utilizes less invasive treatment modalities. Transurethral micro wave therapy (TUMT), transurethral needle ablation of the prostate (TU NA) and a wide variety of laser treatments are the most conspicuous ne w treatment modalities approved or awaiting approval. In general, the alternative treatments produce less improvement in symptoms and peak u rinary flow rates (Q(max)) than open prostatectomy or transurethral re section of the prostate (TURP), which remains the ''gold standard''. H owever, most are promising, particularly because they are associated w ith low morbidity. Long-term outcome has yet to be assessed with any o f the newer treatments and total costs are difficult to calculate. Mos t have proved safe, are feasible on an outpatient basis and which, pro vided a low retreatment rate, will presumably reduce the socioeconomic costs. Although differences are found in outcome, morbidity and costs , none of the newer treatments has demonstrated convincing superiority or established a well-defined niche. In the future, controlled random ized studies against well-documented treatments like TURF or transuret hral incision of the prostate (TUIP), focusing on long-term outcome, q uality of life and socioeconomic costs, are needed. (C) 1998 Prous Sci ence. All rights reserved.