The present role of traditional surgery in the treatment of Benign Prostatic Hyperplasia (BPH)

Surgical treatment is the “gold standard” for the treatment of BPH,it is by far the most effective but also the most invasive.This treatment is necessary when there are complications such asurinary retention, bladder stones, renal dilatation, infection or repeatinghematuria or aggravated symptoms resistant to medicaltreatment.Although open surgery and the transurethral resection were for along time mistakenly opposed, they are in fact two variants of thesame intervention.The decision on which treatment the surgeon chooses depends onthe weight of the gland.Whatever the method chosen, the results are identical (90% ofsymptom score and 80% of urinary flow are normal after two years)but open surgery has proven to be more effective in the long term,as only 5% of the patients who received it needed post-operationtreatment, whereas 40% of those who had a resection did. The complicationswhich result from these treatments are relatively minor:2% experience urethral stenosis, 1% experience urinary incontinence,but 80% experience retrograde ejaculation, and this is somethingof which they must be informed.Of the 6 million men in France over the age of 60 approximately1.2 million are known to have BPH symptoms, yet of this grouponly 58% of them have received medical or surgical treatment.When new medical treatments were introduced in 1990, the needfor surgery dropped considerably, and here France’s figures arerepresentative of Europe’s: surgical intervention is necessary only35% of the time (100 000 / year in 1990 and 66 000 / year in 1997);in America, there has been a 50% drop (300 000 / year in 1990 asopposed to 150 000 / year in 1995).Only 9% of the patients received surgical treatment. Whereas 81%of the patients received transurethral resection; in America the figureis 97%, in Japan 70%.Demographics, however, are not on are side. In just 5 years thereshould be twice as many men over the age of 60 as there are today,which mean that the importance of BPH in medico-economic considerationsis going to increase in a very dramatic fashion.With a 20% prevalence, for a 50-year-old man there is 40% chancethat in the near future, he will need an operation for BPH.Medical treatment, at least less expensive in the beginning, has in fact the same cost as surgery by the 8th year. Economists thereforeerroneously believe that opting for non-surgical treatment willnecessarily minimize the costs.We see here the futility of weighing economic factors againstmedical necessity, as economists omit from their calculations notjust the all-important question of the health risks that often arisefrom delaying surgery, but also the greater long term costs of thenon-surgical treatment of BPH.In conclusion, it is my firm belief that surgery is not only in the bestinterests of the patient, but is also the more cost-effective methodoverall.