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Practice Uncertainties

What is the role of minimally invasive surgical treatments for benign prostatic enlargement?

BMJ 2022; 377 doi: (Published 25 May 2022) Cite this as: BMJ 2022;377:e069002
  1. Juan Victor Ariel Franco1 2,
  2. Jae Hung Jung3,
  3. Camila Micaela Escobar Liquitay4,
  4. Philipp Dahm5
  1. 1Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
  2. 2Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
  3. 3Department of Urology, Yonsei University Wonju College of Medicine, Wonju, South Korea
  4. 4Central Library, Instituto Universitario Hospital Italiano de Buenos Aires, Argentina
  5. 5Minneapolis VAMC, Urology Section and Department of Urology, University of Minnesota, Minneapolis, USA
  1. Correspondence to JVA Franco juan.franco{at}

What you need to know

  • New minimally invasive surgical treatments for benign prostatic enlargement that do not use spinal or general anaesthesia are available for patients experiencing lower urinary tract symptoms

  • Some of these procedures may offer similar improvement in symptoms as traditional surgery, with fewer adverse events, but the evidence is of low to very low quality, short term, and insufficient

  • Refer patients whose condition does not improve with conservative measures and medications to a urologist to discuss surgical options, considering benefits and possible complications, effect on sexual function, and need for retreatment

Benign prostatic enlargement (BPE), also called benign prostatic hyperplasia, is a common cause of lower urinary tract symptoms in men over 50. Increased frequency or urgency of urination, nocturia, difficulty starting urination, or dribbling at the end of urination, are common symptoms.1 BPE is characterised by growth of glands and smooth muscle parts of the prostate and is separate from prostate cancer. In later stages, it can result in bladder outlet obstruction with complications including urinary retention, infection, and possibly impaired renal function.

Initially, if no complications are evident, patients are advised conservative measures such as reducing the amount of fluid intake in the evening, and medications, including α blockers and 5-α reductase inhibitors.2 Surgical ablation to reduce the physical obstruction caused by BPE is an option if symptoms do not improve, patients experience side effects (for example, orthostatic hypotension, which can occur with α blockers, or sexual adverse events with 5-α reductase inhibitors) or do not prefer to take medications long term.

Transurethral resection of the prostate (TURP) is the mainstay of surgical treatment.2 This involves shaving off inner sections of the prostate with an electric loop under direct vision of a cystoscope (fig 1a). TURP requires general (or spinal) anaesthesia and usually catheterisation and admission to …

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