Current aspects of the treatment of benign prostatic hypertrophy?

Surgical treatment, mainly transurethral resection of the prostate, still r emains the reference treatment for benign prostatic hyperplasia (BPH). Two studies conducted in the Urology Department of the Pitie-Salpetriere Hospit al have tried to define cer tain characteristics of this surgery. The first study tried to evaluate the long-term outcome of patients operated for ben ign prostatic hyperplasia. Analysis of 881 replies to a questionnaire sent to 3 147 patients operated for BPH (between 1976 and 1989) assessed functio nal status (by Madsen's symptom score), quality of life (by Fowler's method ), and sex life (by two specific questions), with a follow-up ranging from 5 to 14 years. At this follow-up, 90% of patients declared to be satisfied with their voiding status, 95% considered their quality of life to be excel lent and about 50% had maintained a sex life. The second study was designed to evaluate the morbidity of this treatment in elderly patients. A group o f 33 operated patients over the age of 80 was compared to a control group c omposed of 66 patients between the ages of 60 and 70 years, treated in a si milar way, in the same centre and in the same year. Morbidity was higher in the first group, but age itself did not appear to constitute a poor progno stic factor for surgery; it only intervenes by allowing certain complicatio ns of benign prostatic hyperplasia (acute retention) to create emergency si tuations complicating thepelioperativeperiod. Following demonstration of th e short-term and long-term efficacy of this conventional surgery, many new technologies were subsequently developed in or ner to reduce perioperative discomfort, anaesthetic requirements, duration of catheterization and hospi tal stay. Some of them constitute a new approach to endoscopic surgery, suc h as prostatic tissue vaporization techniques (electrovaporization, laser c ontact vaporization), which have a comparable efficacy to that of TURP: whi le reducing bleeding, catheterization rime and hospital stay. However; the duration of postoperative irritative symptoms is much longer: Other techniq ues use a thermal effect to obtain coagulation necrosis of prostatic tissue , using various energy sources : microwaves (thermotherapy), laser (interst itial laser), radiofrequency waves (TUNA). These techniques are perfectly a dapted to outpatient surgery,vith local or regional anaesthesia. They do no t interfere with continence, sexual function, but may be followed by high d ysuria or retention rates, with a variable cathererization time, sometimes several weeks. Finally, urethroprostatic stents are easy to insert, provide a solution in critical situations and have replaced old indwelling cathete rs. The current choice of treatment therefore comprises several approaches. . more effective, but still purely symptomatic medical treatment, safe conv entional surgery providing excellent long-term results, but generating a ce rtain perioperative discomfort and a certain morbidity, or, on the contrary << minimally invasive >> techniques, greatly simplifying the therapeutic p rocedure but whose morbidity has not yet been determined and whose results are still uncertain.