TURP: Superior results confirm value in treating BPH

May 1, 2008

A leading BPH researcher has presented data demonstrating the persistent value and utility of a time-tested treatment: monopolar transurethral resection of the prostate.

Of note, however, one leading BPH researcher presented data demonstrating the persistent value and utility of a time-tested treatment: monopolar transurethral resection of the prostate.

Results stand test of time

At an average of 9.4 years (range, 7.1 to 11.1 years) of follow-up from the operative procedure, mean age of this cohort was 78.6 years (range, 72 to 78 years). Mean baseline characteristics were an International Prostate Symptom Score (IPSS) of 26 (range, 4 to 35), mean peak flow rate (Qmax) of 8.4 mL/second (range, 2 to 14 mL/second), and quality of life score of 4.8 (range, 2 to 6). The mean Shafer grade was 3.7 (range, 2 to 6) with a detrusor pressure at maximum flow of 85.8 cm/H2O (range, 46 to 156 cm/H2O).

Upon follow-up 9.4 years later, the mean IPSS score was 10.6 (range, 1 to 30), mean Qmax was 17.9 mL/second (range, 4 to 29 mL/second), and the mean quality of life score was 1.6 (range, 0 to 4). Other data reported for these patients were a mean BPH Impact Index of 1.3 (range, 0 to 12), mean International Continence Society (ICS) male voiding symptom score of 3.9 (range, 0 to 12), and mean ICS male incontinence symptom score of 1.7 (range, 0 to 8).

Dr. Gilling, a strong advocate of HoLEP, said the data spoke to the durability and high patient satisfaction levels associated with TURP.

"It still remains a significant challenge for newer techniques to be as good in the long-term as monopolar TURP because the results are so good," he said.

When questioned by the session moderator, Dr. Gilling maintained that his second choice if HoLEP was unavailable "has always been TURP."

Although newer energy sources, operative techniques, and equipment are perpetually being touted as the next major advance in the surgical management of BPH, TURP remains the gold standard. Monopolar TURP is the most commonly performed procedure in the United States and worldwide for BPH, and current data suggest that it will continue to be until a new technique's long-term durability and patient satisfaction are proven superior.

Dr. Gilling is a consultant to Lumenis and an investigator for Uromedica and StarMedTec.