Tratamiento quirúrgico de la hiperplasia prostática benigna: Revisión de la literatura

Background: Benign prostatic hyperplasia is a prevalent pathology. The need for medical or surgical treatment depends on the severity of the lower urinary tract symptoms. The gold standard for surgical treatment is bipolar transurethral resection of the prostate (b-turp). Objective: To evaluate the different surgical techniques, comparing their efficacy and safety in the treatment of benign prostatic hyperplasia. Methods: A narrative review of the literature was carried out through a search of five databases: PubMed, Embase, Lilacs, Science Direct, and GreyNet. Meta-analyses, systematic reviews, and randomized clinical trials published from 2006 to 2016 were evaluated to determine the efficacy and safety of the surgical techniques for the treatment of benign prostatic hyperplasia. Results: A total of 2505 articles were selected by title and abstract and the complete texts of 94 of those articles were reviewed. The different surgical techniques encountered were monopolar turp, bipolar turp, open prostatectomy, plasma vaporization, laser techniques, and minimally invasive ablation techniques. The majority of the articles compared bipolar turp (the gold standard) vs other surgical methods, focusing on clinical outcomes based on the ipss, qmax, pvr, and qoL instruments. The results were similar among all the techniques. Conclusions: Bipolar turp is the most widely practiced technique for benign prostatic hyperplasia management and has good results, compared with monopolar turp. Results are similar between the bipolar turp, holep, thulep, Greenlight laser, and tumt modalities. The choice of surgical technique is dependent on the expertise of the surgeon and the characteristics of each patient. The results of the present review are heterogeneous, making further study necessary.