Advances in TURP: Focus on the science

Dr. Kaplan, a member of the Urology Times Editorial Council, is professor of urology at Weill Cornell Medical College, New York.

Most urologists agree that surgical removal of the enlarged portion of the prostate is the most effective and durable way to manage lower urinary tract symptoms in men secondary to BPH. Where it gets interesting is deriving urologic consensus on the best way to achieve that goal.

Technologies have evolved from traditional monopolar transurethral resection of the prostate (M–TURP) to electrovaporization, numerous iterations of laser methodologies, and most recently, bipolar electrovaporization (B-TURP). Each has its advocates that at times borders on religious fervor.

Bipolar electrovaporization has had increased uptake by urologists throughout the world after initially stalling at gaining wider acceptance. In part, this was due to earlier generators, durability of electrosurgical loops, and transition to a wider-based button technology. The recent systematic review by Omar et al, which included 24 randomized, controlled trials, suggests that B–TURP is as effective as M-TURP but has fewer adverse events, specifically, TUR syndrome, clot retention, and blood transfusion.

Is there a take-home message? We should be careful to broadly pronounce superiority of any technology, much less one that generally has less than 1 year of published experience. Nevertheless, it would appear that there are distinct advantages of B–TURP, specifically with respect to TUR syndrome. We will need broader, prospective trials with more homogenous entry criteria to better analyze costs, duration of hospitalization, and length of catheterization. Moreover, sexual function in the long term needs to be better defined. However, we should be careful to dissociate from the marketing frenzy accompanying many of these new technologies.

Contributing to the marketing frenzy are scattered reports using each system, virtually always reporting amazing results with impressive durability. The bottom line is that urologists and patients should be very wary of rapidly evolving technologies. We should continue to be mindful that newer is often not better; rather, it's just more expensive. Let’s continue to focus on the science. Ultimately, we will figure out what works and what doesn’t.UT

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