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Public release date: 18 December 2008
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Evaluation of treatments for benign prostatic enlargement
Researchers at the University of Aberdeen, led by Professor James N'Dow, examined existing data to determine the risk
factors and clinical and cost-effectiveness of less minimally invasive treatments for benign prostatic enlargement BPE
compared to the current standard of transurethral resection. These included 'tissue ablative' treatments such as holmium
laser enucleation of prostate (HoLEP); transurethral vaporisation; and 'minimally invasive' techniques such as laser
coagulation, microwave therapy and transurethral needle ablation. They also looked at the overall long term benefits
to patients.
Their research, published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme,
has found that transurethral resection (TR), the most common operation for benign prostatic enlargement (BPE), remains a
clinically and cost-effective treatment. BPE commonly causes older men to have difficulty passing urine and may require
surgery to alleviate the problem.
The research team concluded that (TURP) provides a consistent, high level of long-term
symptom improvement. Improvements in quality of life and urinary flow were also observed. The risks associated with the
minimally invasive interventions were generally lower than transurethral resection, with fewer adverse events, such as the
need for a blood transfusion. However, the need for repeat surgery was more common with the newer technologies, especially
the minimally invasive interventions. The evidence also suggests that holmium laser enucleation of prostate (HoLEP) could
offer some advantage over transurethral resection (such as equally good urine flow but shorter hospital stay and reduced
bleeding) although long-term follow-up data is needed.
Methods similar to transurethral resection require an anaesthetic, stay in hospital, and can sometimes lead to unwanted
side effects such as bleeding. However, some patients do not require general anaesthetic and treatment can be performed
within an out patient department using alternative procedures. Newer procedures have been developed but there is
uncertainty about their clinical and cost-effectiveness.
The team leader said, "Overall our findings do not support a change in surgical treatment of BPE and suggests that TURP
should remain the standard approach. Which minimally invasive intervention is most promising is unclear and good quality
randomised controlled trials are needed to prove whether they are superior. Until then personal preference will influence
choice of procedure with some patients choosing minimally invasive treatment options for their decreased morbidity.
The report is also published in the BMJ (British Medical Journal)
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