Long-term effects on BPH of medical and instrumental therapies

A variety of methods are available that provide relief of lower urinary tra ct symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), This paper reviews approaches for assessing treatment outcomes, along with morb idity and long-term reintervention rates for different mechanical treatment s. Symptom scores do not necessarily correlate with the severity of bladder outlet obstruction, whereas reintervention rates provide a reliable object ive measure of long-term outcomes. Less invasive procedures, such as transu rethral needle ablation (TUNA) and transurethral microwave therapy (TUMT), have lower rates of haemorrhage than transurethral resection of the prostat e (TURP) and transurethral vaporisation of the prostate (TUVP), and retrogr ade ejaculation is not seen after TUNA. Reintervention rates are generally low with such treatments, and appear to be lower for TURF than for thermoth erapy and TUNA. In contrast, the secondary intervention rate for contact la ser prostatectomy increases with time after treatment. It can be concluded that the treatment of BPH should be individualised according to patient's n eeds. The staged approach of medical therapy, followed by thermotherapy, th en TURF, is the best approach to minimise the negative impact of LUTS on qu ality of life. Copyright (C) 2001 S.Karger AG. Basel.