Re-examining TUR-P: gold standard for benign prostate obstruction?

Mon, 18 Mar 2013

The role of transurethral prostate resection (TURP) in patients with benign prostate obstruction (BPO) was re-examined during Plenary Session 3 against the backdrop of new technologies such as the use of laser ablation techniques.

TURP is considered as the accepted standard of surgical therapy for the management of symptomatic bladder outlet obstruction due to benign prostatic hyperplasia (BPH). But as a major operative procedure, it has been associated with significant perioperative morbidity.

In recent years, TURP has been somehow pushed to the sidelines amid the popularity of modern laser ablation techniques. In his state-of-the-art lecture, Prof. Michael Marberger (AT) posed the query on whether TURP retains its role as a standard tool in managing prostate obstruction.

“We have today in the market a range of laser devices, perhaps as many as 20 different kinds. Is there a place for TURP or do we consign it to the museum?,” Marberger said, posing the query whether TURP nowadays is still competitive.

He mentioned the various issues associated with TURP such as post-operative retention, blood transfusion and mortality, among others. “TURP has low morbidity and is continuously being improved,” Marberger said noting that the procedure provides an effective and durable solution. Moreover, he said that for TURP to be replaced as a ‘gold’ standard, an alternative has to be “…non-inferior to TURP in results at less morbidity.”

“The alternative also has to be technically simple with standardized technique or technology (that is cost-effective and equipment that is readily available),” he added.

In his closing remarks, Marberger said: “TURP is not a ‘gold standard’ for treating BPO as it has some problems (like bleeding), but it still is the ‘reference standard’ to be met by all alternative treatment options.”