Middle-aged and older men commonly have lower urinary tract symptoms secondary to benign prostatic hypertrophy (BPH). Trans-urethral resection of the prostate (TURP) is the most common surgical treatment, but it fails to resolve symptoms in approximately 20 percent of men. The morbidity rate associated with TURP ranges from 5 to 10 percent, and the mortality rate is approximately 0.2 percent. In addition, 5 percent of patients are impotent after the procedure, and 60 percent have retrograde ejaculation. Because of these risks, the use of noninvasive methods such as drug therapy, laser therapy and even observation alone has increased. Donovan and associates compared the effectiveness of TURP, laser therapy and observation in the treatment of BPH.
Men who had uncomplicated lower urinary tract symptoms related to BPH and no evidence of urinary retention were eligible for the randomized controlled study. Those who met the study criteria were randomized to receive laser therapy, TURP or conservative therapy (observation alone). Five measures were the primary outcomes: the International Prostate Symptom Score (I-PSS), the mean maximum urinary flow rate, a composite measure of success, the mean I-PSS quality of life score and the postvoid residual urinary volume. Secondary outcomes included failure to complete treatment, the need for further treatment, hospitalization, major complications and urodynamics.
A total of 340 men was enrolled in the symptomatic trial, with more than 100 randomized to each of the treatment groups. The baseline characteristics were similar across groups, except for marital status, number actively employed and nonmanual social status. Patients receiving laser therapy and TURP had significantly lower symptom scores than did patients in the conservative management group. TURP performed better than laser therapy, but the difference was not statistically significant. The length of hospital stay and complication rates were significantly less in the laser therapy group compared with those receiving TURP. Time to catheter removal was longer following laser therapy than after TURP.
The authors conclude that both TURP and laser therapy are safe and effective means of treating BPH in men. TURP was more effective than laser therapy but had a higher incidence of complications and longer hospitalization. The authors also note that conservative management consisting of observation only is a safe option.