Surgical Management of Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is a common condition in ageing men characterised by enlargement of the transitional zone of the prostate, leading to lower urinary tract symptoms (LUTS) such as urinary frequency, nocturia and impaired urinary flow. Surgical management remains the mainstay for patients whose symptoms prove refractory to medical therapy or who develop complications such as recurrent urinary retention or renal impairment. Transurethral resection of the prostate (TURP) has long been regarded as the gold‐standard approach, offering reliable relief of obstruction but carrying risks of bleeding, electrolyte disturbance and postoperative catheterisation. Over the past two decades, endoscopic enucleation techniques—most notably holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation (ThuLEP)—have gained traction for their ability to remove large gland volumes with minimal blood loss and short hospital stays. Photoselective vaporisation of the prostate (PVP) utilises high‐power laser energy to create a vapour layer of hyperplastic tissue, offering reduced perioperative morbidity in small to medium glands. More recently, minimally invasive image‐guided methods such as the prostatic urethral lift (PUL), convective water vapour thermal therapy and prostatic artery embolisation (PAE) have been introduced, aiming to preserve sexual function and further shorten convalescence. Selection of technique is guided by prostate size, patient comorbidity, anaesthetic risk and desire to preserve ejaculatory or erectile function. Long‐term outcomes demonstrate durable symptom relief across modalities, while patient preference and resource availability shape real‐world practice in diverse healthcare settings.

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Surgical Management of Benign Prostatic Hyperplasia publication trend

The graph below shows the total number of articles in surgical management of benign prostatic hyperplasia across all publications each year (not limited to Nature Index journals).

Technical terms

Transurethral resection of the prostate (TURP): Endoscopic removal of prostatic tissue using a resectoscope loop and electrocautery.

Holmium laser enucleation of the prostate (HoLEP): En bloc removal of the adenomatous prostate via holmium:YAG laser followed by mechanical morcellation.

Photoselective vaporisation of the prostate (PVP): Laser-based ablation technique using a high-power wavelength absorbed preferentially by haemoglobin to vapourise hyperplastic tissue.

Prostatic urethral lift (PUL): Mechanical insertion of implants to retract lateral prostate lobes, relieving urethral compression without tissue removal.

Rezum system: Convective steam-based thermal therapy delivering targeted water vapour injections to ablate obstructive prostatic tissue.

References

1. Efficacy of a Novel Prophylactic Scheme of Fosfomycin Trometamol in Patients Undergoing Endoscopic Surgery for Benign Prostatic Hyperplasia: Findings from a Prospective Monocentric Single-Arm Study. Antibiotics (2024).
2. Reoperation after surgical treatment for benign prostatic hyperplasia: a systematic review. Frontiers in Endocrinology (2023).
3. Water vapor thermal therapy to alleviate catheter-dependent urinary retention secondary to benign prostatic hyperplasia. Prostate Cancer and Prostatic Diseases (2019).