291 The History for Surgical Treatment of Benign Prostatic Hyperplasia

Abstract

This abstract will summarize the history for surgeries of benign prostatic hyperplasia (BPH). We searched the previous articles about BPH surgeries and summarized it together according to the history development. The BPH has plagued men since antiquity and the real first description of the prostate gland was by Venetian anatomist Nicolo Massa in the 16th century. The earliest operations performed on prostate were in 1639 when French urologist Joseph Covillard described the transperineal incision to remove the prostate tissue in lithotomy position. These surgeries were deemed to be perilous at that period. Even in the Hippocratic Oath, it was warned that “not use the knife, not even on sufferers from stone.” Eugene Fuller in 1895 published an account of six cases of ‘suprapubic prostatectomy’ and illustrated this new improvement. To reduce the high rate of complications and the operation risk, the Irish urologist, Terence Millin developed an open, retropubic approach reported later in 1945. As early as in 1830, George James Guthrie incised the bladder neck with a concealed knife through the urethra, which was the first urethral prostate surgery. However, with no clear surgical view during the operation, haemorrhage and incontinence happened usually. Only until to 1897, A. Freudenberg modified previous methods by combining them with the cystoscope and the ‘blind era’ finally came to an end. Edwin Beer, in 1910, made the application of high-frequency electrical current for the surgery. In the following years, ST. M. Davis reported the transurethral resection of the prostate (TURP) in 1931 which stays as the gold standard for quite a long time. Fortunately, in the 1990s, Peter Gilling for the first time raised the concept of transurethral enucleation of prostate (TUEP) using holmium laser. Later, lots of energy platforms were used in the clinic. Numerous papers have reported that TUEP is safer and more efficient than TURP. The time for TUEP may be coming soon.