Editorials

Endoscopic ablation for benign enlargement of the prostate

BMJ 2008; 337 doi: http://dx.doi.org/10.1136/bmj.39582.425417.BE (Published 30 June 2008) Cite this as: BMJ 2008;337:a535
  1. Sean P Elliott, assistant professor of urological surgery
  1. 1University of Minnesota, MMC 394, Minneapolis, MN 55455, USA
  1. selliott{at}umn.edu

    Newer techniques are no better than transurethral resection, but the evidence base is poor

    The prevalence of prostatic enlargement on rectal examination reaches 50% at age 70 and directly correlates with age.1 The age dependent prevalence of bothersome lower urinary tract symptoms, usually attributed to prostatic enlargement, has been demonstrated in population based studies in many countries, with moderate to severe symptoms being present in 27-56% of men aged 70-79 years in Scotland, France, Japan, and New Zealand.2 3 4 5

    Transurethral resection has been the procedure of choice for surgically treating prostatic enlargement since the 1950s. Its use peaked in the late 1980s and has declined with the introduction of medical treatment and alternative surgical techniques. Drivers of the development of alternative surgical methods include bleeding, electrolyte abnormalities, and prolonged hospital stay associated with transurethral resection. The linked systematic review by Lourenco and colleagues compares several alternative methods of creating an immediate opening in the prostatic urethral channel …

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