Surgical treatment of benign prostatic hypertrophy is aimed at removing the obstructing adenoma, once pharmacological treatment has not fulfilled its expectations, there is no desire to suffer the side effects of the same or there is a progression in the disease.
Open or laparoscopic adenomectomy
It is the first technique that emerged in time: Freyer (1900) and Millin (1946). It is still in use today and its excellent long-term functional results are imitated by the other techniques. Its greater aggressiveness has relegated it to the treatment of very large prostates. It can be reproduced laparoscopically, which is less aggressive but more technically complex.
Transurethral resection
It began with McCarthy in 1945. It is the most widespread procedure and has evolved over the years with instrumental improvements – resector – and electrical energy sources that allow the use of saline. It eliminates the adenoma from the urethral lumen, cutting it into fragments.
Transurethral vaporization
It manages to eliminate the adenoma also from the urethral lumen, vaporizing it. For this purpose, laser energy began to be used in different modalities – green, red, thulium, etc. It has had a wide diffusion in a few years, thanks to its minimal aggressiveness and little bleeding.
The disadvantages are its high cost and difficulty in treating large prostates. Since 2008, a plasma vaporizer has been available which, with the same results, has a reduced cost.
Transurethral enucleation
Finally, transurethral enucleation attempts to reproduce open surgery but through the urethra. The technique was described by P. Gilling in 1998, which used the holmium laser to enucleate and a morcellator to remove the enucleated lobes.
It makes it possible to treat large prostates. It is a more complex and expensive technique. In 2011 we started to develop a new technique: Transurethral Plasma Enucleation. It is based on the previous one, using a plasma vaporizer to enucleate and a conventional loop to remove the enucleated lobes, all with a single tool – Olympus resector-, with lower cost and less complexity of realization.