Transurethral resection of the prostate revisited and updated

Abstract

Electrosurgical transurethral resection (TUR) of the prostate (TURP) has dominated symptomatic benign prostatic hyperplasia (s-BPH) surgical treatment for almost a century. We analysed recent TURP publications, with emphasis on durability, morbidity, new technology advantages, future generation training and malignant disease. TURP has declined due to medical therapy, but transcends other surgical challengers by proven outcomes durability over a decade. Adopting the modified-Clavien system may aid future morbidity comparisons. Properly used bipolar technology reduces major bleeding and seemingly abolishes TUR syndrome, but requires further study in anticoagulated patients. Residents are disturbingly short of TURP exposure, consequently experiencing more complications. Solutions include switching to ablative laser prostatectomy (which may carry higher long-term retreatment rates), adoption of bipolar technology, or simulator development and implementation. Concurrently performed transurethral resection of bladder tumor-TURP seems oncologically acceptable (in selected cases); incidentally detected significant prostate cancer at TURP may have declined, whereas TURP for prostate cancer may indicate the need for earlier androgen deprivation. TURP is still rightly the dominant, most widely performed, versatile and cost-effective surgical treatment for s-BPH, reducing morbidity further with technical and technological developments. A better evidence base is required for newer technologies through large well designed multicentre-multinational randomized controlled trials incorporating standardized morbidity and long-term outcomes reporting.