Surgical and nonsurgical invasive treatment of benign prostatic hyperplasia

A third era in the surgical treatment of benign prostatic hyperplasia (BPH) utilizes less invasive treatment modalities. Transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA) and a wide variety of laser treatments are the most conspicuous new treatment modalities approved or awaiting approval. In general, the alternative treatments produce less improvement in symptoms and peak urinary flow rates (Q(max)) than open prostatectomy or transurethral resection of the prostate (TURP), which remains the "gold standard". However, most are promising, particularly because they are associated with low morbidity. Long-term outcome has yet to be assessed with any of the newer treatments and total costs are difficult to calculate. Most have proved safe, are feasible on an outpatient basis and which, provided a low retreatment rate, will presumably reduce the socioeconomic costs. Although differences are found in outcome, morbidity and costs, none of the newer treatments has demonstrated convincing superiority or established a well-defined niche. In the future, controlled randomized studies against well-documented treatments like TURP or transurethral incision of the prostate (TUIP), focusing on long-term outcome, quality of life and socioeconomic costs, are needed.