Surgical procedures for benign prostatic hyperplasia: a nationwide survey in Japan

We investigated the trend in surgical procedures for benign prostatic hyperplasia (BPH) during the past 10 years in Japan. A questionnaire inquiring about the number of operations and surgical procedures for BPH in 1999, 2004 and 2009 was sent to 1824 institutes belonging to the Japanese Urological Association and/or the Japanese Clinical Urologists Association. Responses were obtained from 767 institutes (42.1%). The number of operations showed a gradual increase during the 10 years (n = 17,221 in 1999, 18,772 in 2004, 20,413 in 2009). Transurethral resection of the prostate, including transurethral resection in saline, was consistently the most common procedure (72.5% to 79.2%). Holmium laser enucleation of the prostate and transurethral enucleation with a bipolar system have dramatically increased, becoming the second most common in 2009 (n = 3416), although enucleation by open prostatectomy was still a viable option in 2009 (n = 555). Photoselective vaporization of the prostate was the third most common method in 2009 (n = 572). Coagulation and thermotherapy have become uncommon (n = 2039 in 1999, 217 in 2009), whereas incision and stenting were unchanged during the period. Thus, surgical procedures for BPH have been increasing in Japan during the past decade. Transurethral resection remains the standard, whereas enucleation and vaporization have been increasing.