Open adenomectomy: past, present and future

Open surgery has been the gold standard for the treatment of benign, symptomatic, large volume prostatic hyperplasia. Recent data series, however, have demonstrated that a minimally invasive approach can be used for the treatment of this pathology while duplicating the results of the open technique. This review will describe the different surgical techniques that have been used through the last century for the treatment of benign prostatic hyperplasia, highlighting the advantages and disadvantages of each approach.

Surgical management for symptomatic benign prostatic hyperplasia has made a journey from an open approach to robotic surgery. Modifications of the gold standard transurethral resection have been incorporated into clinical practice and include bipolar transurethral resection as well as holmium laser resection and potassium titanyl phosphate laser vaporization. Minimally invasive ablative techniques have also been popularized and include transurethral needle ablation and thermotherapy. Most recently, laparoscopy has demonstrated to be a feasible, safe, reproducible technique that can create similar outcomes to an open technique whilst maintaining the advantages of a minimally invasive approach. Although the future will see greater use of robotics, larger series are needed to prove the advantages of this technology.

Minimally invasive approaches for the treatment of symptomatic benign giant prostatic hyperplasia are replacing open surgery, which has been the gold standard for the surgical treatment of this pathology, duplicating its results with a lower morbidity. Recently we have seen a growing amount of experience treating this disease state with laparoscopic/robotics and the advantages it provides may permit the popularization of this technique.