Benign prostatic hyperplasia: A new look at an old operation
Benign prostatic hyperplasia (BPH) is an important cause of distress in older men. It can produce urinary frequency and urgency as well as a slow urinary stream, dribbling, and incomplete emptying of the bladder. BPH is also an important cause of nocturia — nighttime urination. The symptoms begin to mount as men enter their 60s, and they continue to increase as the prostate continues to enlarge over time. By the age of 80, about 25% of all men have BPH that is bothersome enough to require treatment, and countless others have mild symptoms they can "live with." In all, an estimated 5.5 million American men have clinically significant BPH, and about two million seek medical help for their symptoms every year.
Until recently, men who asked for help got it in the form of an operation devised more than 75 years ago, the transurethral resection of the prostate (TURP). As recently as 1995, about 400,000 TURPs were performed in the United States each year. Since then, however, the number has declined dramatically, even though doctors still view it as the "gold standard," the surest way to relieve symptoms of BPH. The decline hasn't been triggered by any problems with the operation itself — it's actually gotten better and safer — but by three important developments: