From the Guidelines
Transurethral resection of the prostate (TURP) is the gold standard surgical treatment for men with benign prostatic hyperplasia (BPH) to improve urinary retention, as it has been shown to provide significant symptom reduction and flow rate improvement 1. Several surgical procedures can improve urinary retention depending on the underlying cause. For men with BPH, alternative procedures to TURP include:
- Laser prostatectomy (HoLEP, GreenLight)
- UroLift (prostatic urethral lift), which may be offered as an option for patients with LUTS attributed to BPH provided prostate volume <80g and verified absence of an obstructive middle lobe 1
- Rezum (water vapor therapy)
- Prostate artery embolization For urethral strictures, direct vision internal urethrotomy (DVIU) or urethroplasty may be performed. Women with pelvic organ prolapse causing retention might benefit from procedures like cystocele repair. Sacral neuromodulation (InterStim) can help patients with non-obstructive retention by electrically stimulating the sacral nerves that control bladder function. Botulinum toxin injections into the external urethral sphincter can help patients with detrusor-sphincter dyssynergia. The choice of procedure depends on the specific cause of retention, patient characteristics, and comorbidities. Most procedures are performed under general or spinal anesthesia and require varying recovery periods from outpatient to several days of hospitalization. Success rates vary by procedure and patient selection, with TURP showing significant long-term improvement for BPH-related retention 1.
From the FDA Drug Label
Patients (%)* Event Placebo N=1503 Finasteride N=1513 Relative Risk† 95% CI P Value† Table 5: All Treatment Failures in A Long-Term Efficacy and Safety Study All Treatment Failures 37.1 26.2 0.68 (0.57 to 0.79) <0.001 Surgical Interventions for BPH 10.1 4.6 0.45 (0.32 to 0.63) <0.001 Acute Urinary Retention Requiring Catheterization 6.6 2.8 0. 43 (0.28 to 0.66) < 0.001
The surgical procedures to improve urinary retention are not explicitly stated in the provided drug label. However, it is mentioned that surgical interventions for BPH were reduced by 55% in the finasteride group compared to the placebo group.
- The specific surgical procedures are not mentioned, but it can be inferred that they are related to BPH-related urological events, such as:
- TURP (Transurethral Resection of the Prostate), as shown in Figure 2. The FDA label does not provide a comprehensive list of surgical procedures to improve urinary retention. 2
From the Research
Surgical Procedures for Urinary Retention
Surgical procedures can be an effective way to improve urinary retention, especially in cases where benign prostatic hyperplasia (BPH) is the underlying cause. Some of the surgical procedures that can improve urinary retention include:
- Transurethral resection of the prostate (TURP) 3, 4, 5, 6, 7
- Transurethral incision of the prostate (TUIP) 4
- Transurethral enucleation procedures 5
- Laser therapy, such as neodymium:YAG noncontact visual prostate ablation 7
- Open prostatectomy 4
- Minimally invasive procedures, such as electrovaporisation, laser prostatectomy, transurethral needle ablation, high intensity focused ultrasound, transurethral microwave therapy, and insertion of prostatic stents 4
Comparison of Surgical Procedures
Studies have compared the effectiveness of different surgical procedures for urinary retention. For example:
- A study found that TURP provided more favorable clinical outcomes compared to conservative medical treatment in patients with urinary retention caused by BPH 3
- Another study found that TURP was more effective than laser therapy in men with chronic urinary retention, but had higher complication rates and longer hospital stays 7
- A study found that transurethral enucleation procedures had a better risk profile than TURP in some cases 5
Considerations for Surgical Procedures
When considering surgical procedures for urinary retention, it's essential to take into account the patient's individual needs and preferences. Factors to consider include: