Benign prostatic hyperplasia (BPH) is a common condition in older men and can cause significant urinary symptoms. When pharmacological treatments are ineffective, surgical options may be considered. The main surgical techniques include:

1. TURP (Transurethral Resection of the Prostate)

TURP is considered the “gold standard” for the treatment of BPH. It involves the endoscopic resection of the prostate through the urethra. This procedure uses a resectoscope to remove excess prostatic tissue, alleviating the obstruction of the urethral channel and improving urinary flow. The main advantages include relatively quick recovery and good symptom control. Possible complications include:

• Retrograde ejaculation: semen is emitted not in anterograde fashion, outward, but toward the bladder.
• Urinary incontinence
• Urethral stricture
• Erectile dysfunction

2. HoLEP

HoLEP is a valid alternative to TURP and offers the possibility of endoscopically treating larger prostates that previously required open surgery. This procedure utilizes a holmium laser to enucleate prostatic tissue. This method is minimally invasive and allows for the removal of large amounts of prostatic tissue with less blood loss compared to TURP. Additionally, HoLEP offers rapid postoperative recovery and a low risk of complications.

3. Urolift

Urolift is a relatively new procedure that uses small implants to lift and hold open the prostatic lobes that compress the urethra, thereby improving urinary flow. This procedure is minimally invasive and does not involve the resection of prostatic tissue, which reduces the risk of complications and recovery time. Urolift is suitable for patients with moderately sized prostates and has the advantage of preserving sexual function. It is therefore not indicated for patients with very large prostates or with the presence of a median lobe.

4. Tpla (Transperineal Laser Ablation):

Transperineal eco-guided laser interstitial ablation is an innovative technique for the treatment of BPH. It is a minimally invasive technique that can be performed with simple sedation or local anesthesia and utilizes a low-power laser. The main difference from other techniques is that it adopts a transperineal rather than a transurethral approach. This helps reduce the risk of complications related to urethral trauma, such as urethral strictures, and preserves ejaculation.

The choice of the best procedure depends on various factors, including the size of the prostate, the patient’s overall health conditions, personal preferences, and the surgeon’s experience. It is essential to discuss with the attending physician to find the most suitable option for the patient’s specific needs.

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