Evolution of minimally invasive surgical treatments for benign prostatic obstruction

Transurethral resection of the prostate (TURP) has been the established surgical gold standard for the treatment of prostatic obstruction due to benign prostatic hyperplasia(BPH). Prior to TURP, the mainstay of surgical treatment was open suprapubic prostatectomy (SPP), which carried a high risk of morbidity and mortality. TURP did not go through rigorous assessment of outcomes or comparison with SPP in order to become labeled as the gold standard. TURP is still a procedure with potential significant morbidity, particular with regard to hemorrhage and surgical misadventure. In the mid to late 1990’s, there began efforts to find less morbid alternatives to TURP. Most of these early attempts fell out of favour due to clinical outcomes failing to meet both surgeon and patient expectations. In the 2000’s newer alternative treatment options such as photoselective vaporization of the prostate (PVP) and the prostatic urethral lift (PUL) have emerged and have progressively been introduced into clinical practice. Studies of these technologies form the basis of this DMedSci thesis. The use of the green wave length laser (532nm) to perform PVP is shown in a series of manuscripts to demonstrate it’s effectiveness and morbidity in treating various populations of men with lower urinary tract symptoms due to BPH. PUL is a minimally invasive treatment that has been shown in this series of manuscripts to relieve urinary symptoms rapidly and without any deleterious effect on sexual function. Readers are taken through the journey of how this technology has progressed from first-in-man studies through to entry into mainstream clinical practice