TURP is associated with risk for blood loss and longer hospital stays, but minimally invasive procedures are less effective in improving symptom scores.
Although transurethral resection of the prostate (TURP) is an effective treatment for patients with benign prostatic hyperplasia (BPH), it has disadvantages, including blood loss and requisite multiday hospitalization. Minimally invasive surgical BPH treatments, such as transurethral microwave thermotherapy, transurethral needle ablation, and laser coagulation, reduce prostate volume through delayed tissue necrosis and generally involve shorter inpatient stays. In this meta-analysis of 22 randomized controlled trials (involving 2434 men with BPH), U.K. investigators compared the effectiveness (at 12 months after surgery) of minimally invasive treatments versus TURP.
Needle ablation was significantly less effective than TURP in improving mean BPH symptom scores. All three minimally invasive treatments were significantly less effective than TURP in improving peak urine flow rate. Also, patients who underwent needle ablation and laser coagulation were significantly more likely to require reoperation than were patients who underwent TURP. However, compared with TURP patients, patients who underwent minimally invasive treatments had significantly shorter mean hospital stays and were significantly less likely to experience loss of ejaculation; those who underwent needle ablation and laser coagulation were significantly less likely to experience erectile dysfunction and to require blood transfusions.
Comment: The quality of studies included in the analysis was only moderate-to-poor. Even so, these results suggest that patients who undergo minimally invasive surgical treatments are less likely to experience improved urine flow and more likely to experience urine retention than are patients who undergo TURP. Nevertheless, minimally invasive treatments might be preferred for patients who cannot tolerate adverse events associated with TURP. For such patients, however, which minimally invasive treatment is best is unclear.
— Paul S. Mueller, MD, MPH, FACP
Published in Journal Watch General Medicine October 30, 2008
Lourenco T et al. Minimally invasive treatments for benign prostatic enlargement: Systematic review of randomised controlled trials. BMJ 2008 Oct 9; 337:a1662.