Surgical Removal of Prostate: New Advances in The Treatment of Benign Prostate Hypertrophy (BPH)-An Updated Review for Surgeons and Anesthesiologists

Abstract

Background: Benign prostatic hyperplasia (BPH) is a common condition that leads to lower urinary tract symptoms (LUTS), affecting many men, particularly those over the age of 80. It is characterized by the proliferation of epithelial and stromal cells in the prostate, causing urethral obstruction. The primary causes of BPH include hormonal imbalances, particularly the roles of dihydrotestosterone (DHT) and estrogen. Traditional management strategies include pharmacotherapy and surgical interventions, with transurethral resection of the prostate (TURP) being the gold standard.

Aim: This review aims to evaluate and compare the latest advances in minimally invasive surgical treatments for BPH, focusing on their efficacy, safety, and long-term outcomes. The study also focus on the main role of Anesthesiologists.

Methods: A systematic review of literature from 1993 to 2022 was conducted. Studies were identified through PubMed, Cochrane Library, and other databases using Boolean search strings related to BPH and various surgical treatments. Both clinical trials and observational studies were included to assess the outcomes of different minimally invasive treatments such as prostatic artery embolization (PAE), transurethral needle ablation (TUNA), and others.

Results: Minimally invasive techniques like PAE, TUNA, and laser treatments offer viable alternatives to traditional surgery, especially for patients who are not candidates for standard procedures. PAE has shown significant improvements in symptom relief with fewer side effects and lower costs compared to TURP, though long-term data is still limited. TUNA and other approaches also demonstrate promising outcomes in symptom reduction and patient satisfaction, especially in patients unfit for more invasive surgeries.

Conclusion: Minimally invasive procedures are effective alternatives to traditional surgical methods in managing BPH symptoms, particularly for patients with large prostates or those at high surgical risk. Further studies are needed to determine the long-term efficacy and safety of these interventions.