Long-term effects on BPH of medical and instrumental therapies

A variety of methods are available that provide relief of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). This paper reviews approaches for assessing treatment outcomes, along with morbidity and long-term reintervention rates for different mechanical treatments. Symptom scores do not necessarily correlate with the severity of bladder outlet obstruction, whereas reintervention rates provide a reliable objective measure of long-term outcomes. Less invasive procedures, such as transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT), have lower rates of haemorrhage than transurethral resection of the prostate (TURP) and transurethral vaporisation of the prostate (TUVP), and retrograde ejaculation is not seen after TUNA. Reintervention rates are generally low with such treatments, and appear to be lower for TURP than for thermotherapy and TUNA. In contrast, the secondary intervention rate for contact laser prostatectomy increases with time after treatment. It can be concluded that the treatment of BPH should be individualised according to patient's needs. The staged approach of medical therapy, followed by thermotherapy, then TURP, is the best approach to minimise the negative impact of LUTS on quality of life.