Transition in surgical management of benign prostatic hyperplasia in a tertiary centre: From TURP to contemporary minimally invasive and laser therapies

Title : Transition in surgical management of benign prostatic hyperplasia in a tertiary centre: From TURP to contemporary minimally invasive and laser therapies

Abstract:

Introduction: Transurethral resection of the prostate (TURP) has been the gold standard surgical treatment for benign prostatic hyperplasia (BPH). However, minimally invasive surgical therapies (MIST) and laser-based approaches are increasingly adopted. We evaluated the evolution of BPH surgical practice at our tertiary centre and compared perioperative outcomes.

Materials and Methods: A retrospective review was performed of 296 patients between September 2023 and April 2026. Procedures included TURP (193), UroLift (28), iTIND (10), Rez?m (27), and HoLEP (38). Total institutional procedural volume during this period was TURP (410), HoLEP (72), iTIND (16), Rez?m (35), and UroLift (32). Outcomes included length of stay (LOS), complications, symptom outcomes, and reintervention.

Results: A progressive shift away from TURP toward MIST and laser therapies was observed. Day-case management was achieved in all iTIND and Rez?m cases and 96.4% of UroLift procedures. HoLEP achieved comparable LOS despite treating significantly larger prostates than TURP (mean 121.4cc vs 56.7cc); 73% of HoLEP patients were discharged on postoperative day 1 compared with 51.8% following TURP.

Functional outcomes improved markedly following HoLEP (IPSS 22.5→4.5; QoL 4.47→1.23), compared with after TURP (IPSS 20.3→14). TURP showed higher perioperative morbidity, including urosepsis (4.1%), haematuria (4.7%), and TWOC failure (19.7%), compared with HoLEP (2.6%). Reintervention rates within one year were highest in UroLift (14.3%), Rez?m (7.4%) compared to TURP (0.5%), HoLEP (2.6%) and iTIND (0%).

Urinary incontinence occurred in 7.3% of TURP patients and 10.2% of HoLEP patients (when performed by multiple training surgeons) and 2% with a single main surgeon, compared to UroLift (3.6%), iTIND (10%), and Rez?m (0%).

Conclusion: Our institutional experience demonstrates a shift toward MIST and laser-based surgery. While MIST offers excellent recovery profiles, HoLEP delivered durable functional improvement and favourable perioperative outcomes in a more complex patient population, supporting its expanding role in contemporary BPH management.

Biography:

Pranavi is a Core Surgical Trainee at the Royal Liverpool University Hospital, with a keen interest in pursuing a career in Urology. She is currently gaining valuable clinical and surgical experience within the Urology Department, working alongside consultants across a range of urological conditions and procedures. she is passionate about research and is actively involved in projects aimed at improving patient outcomes and advancing surgical practice within the field. Her dedication to combining clinical training with academic development reflects her commitment to becoming a skilled and well-rounded urological surgeon.