Published online Nov 24, 2014. doi: 10.5410/wjcu.v3.i3.370
Revised: June 27, 2014
Accepted: July 25, 2014
Published online: November 24, 2014
Processing time: 204 Days and 18.9 Hours
AIM: To investigate the best surgical treatment for very large benign prostatic obstruction (BPO).
METHODS: A revision of literature was conducted in PubMed database with 167 search results. Key words for the search were benign prostatic hyperplasia, surgical treatment, large, and volume. Inclusion criteria for this study were surgical treatment of benign prostatic obstruction for prostates equal to or larger than 80 cc. Among article search results, 9 completed inclusion criterion and were revised. Each surgical technique included in those articles was compared to each other. The results were observed, and conclusions derived from this are presented. There is no statistical analysis.
RESULTS: Of the 5 techniques presented in the revised articles [open transvesical enucleation, holmium laser enucleation of the prostate (HoLEP), photoselective vaporization of the prostate using potassium titanyl phospate laser, transurethral resection with bipolar energy, and transurethral enucleation with bipolar energy], open transvesical enucleation best permits the resolution of obstructive symptoms. It presents excellent maximum flow rates, high resected tissue volume and maintenance of results over time. These characteristics explain why it has been the gold standard treatment for prostates greater than 80 cc. However, it is at the expense of greater blood loss, urethral catheter and hospital stay times. Since its initial application in 1996, the transurethral enucleation of the prostate by means of a holmium laser has become a procedure that has similar surgical outcomes with fewer complications when compared to open surgery making it an interesting alternative for very large BPO. Nonetheless, no procedure has removed open surgery as the gold standard for very large BPO.
CONCLUSION: Open surgery has proved to be the gold standard for very large BPO. HoLEP appears as a minimally invasive alternative with same benefits but less morbidity.
Core tip: Though the gold standard for surgical treatment of very large benign prostatic obstruction has been open prostatectomy, in the last three decades there has been a notorious absence of publications showing the outcomes of this surgery. The only procedure with similar results and fewer complications seems to be the holmium laser enucleation of the prostate making it an interesting alternative when confronted with large sized prostates. New methods of treating large prostates have an interesting challenge since both open surgery and holmium laser enucleation of the prostate present favorable results.