[Surgical and instrumental management of benign prostatic hyperplasia]

In recent decades, several various interventional procedures for the treatment of symptomatic benign prostatic hyperplasia (BPH) have been developed. Most of them were considered potential alternatives to prostatic surgery such as open prostatectomy, transurethral resection of the prostate (TURP), or transurethral incision of the prostate (TUIP). Despite good results observed in the initial clinical studies, most concepts and procedures were never generally accepted. However, they contributed considerably to general knowledge regarding the treatment of symptomatic and obstructive BPH. Only a few procedures could stand the test of time and became part of the urological armamentarium. Currently, interventional therapies are classified by their effects on prostate tissue: procedures with immediate tissue ablation (open prostatectomy, TURP, vaporization techniques, laser resection techniques), thermal coagulating procedures with delayed tissue ablation (transurethral high-energy microwave thermotherapy, transurethral needle ablation, interstitial laser coagulation), and other procedures (TUIP, stents) with deobstruction effects without tissue ablation. The analysis of clinical studies shows a great variety of different results. The main reason for this fact is that the design of past and present studies ignored the pathophysiological aspects of BPS, especially the obstructive component, and the fact that the outcome of most procedures more or less depends on the operator/user.