Selection of the surgical procedure for management of benign prostatic hyperplasia

The standard method of surgically treating obstructing benign prostatic hyperplasia is transurethral resection of the prostate. It is the gold standard by which other therapeutic modalities, medical and surgical, should be measured. In those patients with larger prostate, open prostatectomy is the procedure of choice. Transurethral incision of the prostate has been under-utilized and would be useful in the majority of patients. The procedure is best used in patients who have glands under 30 grams and preferably around 20 grams in size. Therefore, in a given patient, the surgical procedure will be dependent upon the patient's general condition, the anatomy and size of his prostate, and the surgeon's skill and experience. Newer less invasive procedures are currently under evaluation and must be compared to transurethral prostatectomy, so that we can determine their possible role in the armamentarium of the urologist. Prospective randomized studies, comparing these new modalities to TUR-P, are needed, particularly with long-term outcome data.