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TURP, laser prostatectomy, electrovaporization comparable for BPH

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – For benign prostatic hyperplasia (BPH), transurethral resection of the prostate (TURP), contact laser prostatectomy, and electrovaporization of the prostate provide similar improvements in symptoms and quality of life, long-term data suggest.

Although TURP was the only treatment that produced a statistically significant increase in maximum urinary flow rate at 10 years, the improvement was small and of “little clinical relevance,” lead author Dr. Robert J. Hoekstra, from University Medical Center, Utrecht, the Netherlands, and colleagues note.

Their findings, reported online February 22nd in BJU International, stem from a study of 150 men with suspected BPH who were randomized to undergo one of the three treatments from 1996 to 2001. In 2008, 66 (44%) were available for follow-up (average follow-up = 10.1 years), including 29 who from the TURP group, 20 who had contact laser prostatectomy, and 17 treated with electrovaporization. At baseline, they all had prostate volumes of 20 to 65 mL and a Schafer’s obstruction grade of 2 or higher.

All three treatments provided significant, sustained, and similar improvements in the International Prostate Symptoms Score, Symptom Problem Index, BPH Impact Index, and quality of life.

The 10-year actuarial failure rates for TURP, laser treatment, and electrovaporization were 0.11%, 0.22%, and 0.23%, respectively. The was no difference in mortality between the groups.

“There were relatively few patients” in this study, “making the statistical power low,” the researchers note.

They would like to see long-term randomized controlled trials of some of the newer minimally invasive techniques. “Currently, photoselective vaporization of the prostate using potassium-titanyl-phosphate laser is considered the most promising procedure,” the authors say. “ This new technique was first described in 2003, reporting good outcomes and minimal morbidity up to a mean follow-up of 3 years.”

“Holmium enucleation of the prostate is also a widely used technique reporting good results with a follow-up to 6 years,” they add.

In the meantime, the researchers conclude, the long-term results of their study support TURP, laser treatment, and electrovaporization as reasonable treatment options for men with lower urinary tract symptoms suggestive of BPH.

Reference:

BJU Int 2010.