Surgical Options for Benign Prostatic Hyperplasia (BPH)

In 1788 John Hunter first described the pathology of prostatic hyperplasia and its effects on the upper urinary tract. It took a century for the first suprapubic prostatectomy to be carried out in 1887 by AF McGill in Leeds (though Americans tend to claim credit to Fuller in New York in 1894.) The procedure was subsequently p o p u l a r i s e d b y S i r Pe t e r F r e ye r . R e t r o p u b i c prostatectomy was first performed in 1908 but failed to attract attention until it was reintroduced by Terrence Millin in 1947. Since then, it remains the open operation of choice in UK for BPH. In 1909 H H Young introduced the transurethral cold punch resection of the prostate. M Stern introduced the first resectoscope in 1926 and shortly afterwards H Bumpus at Mayo Clinic introduced diathermy cutting and coagulation. In 1932 Joseph McCarthy introduced the fore-oblique lens, continuous irrigation and working element for resection, and performed the first series of transurethral resection of prostate (TURP) in a manner similar to what we are doing today. With further advances in technology and technique, TURP became established as the most commonly performed operation for BPH, and the open procedures are relegated only to situations where TURP are difficult or risky. This combination essentially formed the gold standard of surgery for BPH we are still adopting today. However, TURP is not without its complications. It keeps on evolving in technology under pressure for fewer complications. Other new technologies also sprang up in the last two decades utilising other forms of energy to achieve tissue destruction or removal in BPH. Many such techniques came and went. However, some stay as useful adjunct to the gold standard of TURP with open surgery back up, and appear promising as new directions for further evolution of intervention for BPH. This article orientates the reader through the myriad of contemporary procedures Hong Kong urologists are practising or have come across.