Evaluation Of Treatments For Benign Prostatic Enlargement

Main Category: Prostate / Prostate Cancer
Article Date: 22 Dec 2008 - 1:00 PDT

email to a friend   printer friendly   opinions  

Research published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme has found that transurethral resection, the most common operation for benign prostatic enlargement (BPE), remains a clinically and cost-effective treatment. BPE commonly causes older men to have difficulty passing urine and may require surgery to alleviate the problem.

Researchers at the University of Aberdeen, led by Professor James N'Dow, examined existing data to determine the risk factors and clinical and cost-effectiveness of less minimally invasive treatments for BPE compared to the current standard of transurethral resection. These included 'tissue ablative' treatments such as holmium laser enucleation of prostate (HoLEP); transurethral vaporisation; and 'minimally invasive' techniques such as laser coagulation, microwave therapy and transurethral needle ablation. They also looked at the overall long term benefits to patients.

Methods similar to transurethral resection require an anaesthetic, stay in hospital, and can sometimes lead to unwanted side effects such as bleeding. However, some patients do not require general anaesthetic and treatment can be performed within an out patient department using alternative procedures. Newer procedures have been developed but there is uncertainty about their clinical and cost-effectiveness.

The research team concluded that transurethral resection provides a consistent, high level of long-term symptom improvement. Improvements in quality of life and urinary flow were also observed. The risks associated with the minimally invasive interventions were generally lower than transurethral resection, with fewer adverse events, such as the need for a blood transfusion. However, the need for repeat surgery was more common with the newer technologies, especially the minimally invasive interventions. The evidence also suggests that HoLEP could offer some advantage over transurethral resection (such as equally good urine flow but shorter hospital stay and reduced bleeding) although long-term follow-up data is needed.

Professor James N'Dow said, "Overall our findings do not support a change in surgical treatment of BPE and suggests that TURP should remain the standard approach. Which minimally invasive intervention is most promising is unclear and good quality randomised controlled trials are needed to prove whether they are superior. Until then personal preference will influence choice of procedure with some patients choosing minimally invasive treatment options for their decreased morbidity.

To view full details about the project visit http://www.hta.ac.uk/1468
The report is also published in the BMJ. http://www.bmj.com/cgi/content/abstract/337/oct09_2/a1662?ct
http://www.bmj.com/cgi/content/abstract/337/jun30_1/a449

1. The HTA programme is a programme of the National Institute for Health Research (NIHR) and produces high quality research information about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest of the NIHR programmes and publishes the results of its research in the Health Technology Assessment journal, with over 440 issues published to date. The journal's 2007 Impact Factor (3.87) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, http://www.hta.ac.uk The HTA programme is coordinated by the NIHR Coordinating Centre for Health Technology Assessment (NCCHTA), based at the University of Southampton.

2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients.

National Institute for Health Research

• Additional
• References
• Citations