SURGICAL INTERVENTIONS FOR BENIGN PROSTATIC HYPERPLASIA: A COMPARATIVE REVIEW OF CONTEMPORARY TECHNIQUES

Abstract

Background: Benign prostatic hyperplasia (BPH) is among the most prevalent urological conditions affecting men over 50, with significant impact on quality of life. Surgical management has evolved substantially over recent decades, yielding a spectrum of procedures ranging from classical open prostatectomy to minimally invasive endoscopic and laser-based techniques. Objective: To systematically compare efficacy, safety, perioperative outcomes, and patient-reported outcomes across major BPH surgical modalities, including transurethral resection of the prostate (TURP), holmium laser enucleation (HoLEP), photoselective vaporization (PVP), prostatic urethral lift (PUL), and simple open prostatectomy (OP). Methods: A narrative comparative review of prospective studies, randomized controlled trials, and meta-analyses published between 2010 and 2024 was conducted. Outcomes assessed included International Prostate Symptom Score (IPSS) improvement, maximum urinary flow rate (Qmax), post-void residual volume (PVR), hospitalization duration, catheterization time, and complication rates. Results: All evaluated procedures demonstrated significant IPSS improvement and Qmax increase. TURP remains the reference standard with robust efficacy, while HoLEP demonstrates superior enucleation efficiency and lower retreatment rates in large-volume prostates. PVP and PUL offer favorable bleeding profiles suitable for anticoagulated patients. Open prostatectomy retains a role in very large glands (>100 mL). Conclusion: Procedure selection should be individualized based on prostate volume, patient comorbidities, surgeon experience, and preservation of sexual function. Emerging technologies continue to redefine the surgical management landscape of BPH.