Advances in the surgical treatment of benign prostatic hyperplasia and implications for perioperative anesthetic management

Abstract

Benign prostatic hyperplasia (BPH) is a highly prevalent disease in men worldwide. Lifestyle changes and medication are the first two steps in treating this condition, with surgery reserved for cases of treatment failure or the appearance of complications such as hematuria, bladder stones, recurrent urinary tract infections, or urinary retention.

Before the introduction of transurethral resection of the prostate (TURP), patients with BPH underwent open surgical procedures. TURP was an innovation that demonstrated that prostatic tissue could be resected through a cystoscope, making it possible to safely remove most of the adenoma near the prostatic capsule. In the last 15 years, further advances have been made, demonstrating that endoscopic enucleation of the prostatic adenoma with laser can be performed, similar to open surgery.

Irrigation fluid absorption is multifactorial and leads to cardiovascular, central nervous system, and metabolic disturbances, resulting in the well-known post-TURP syndrome. The clinical presentation of this syndrome varies depending on the characteristics of the irrigation fluid.

With the evolution of TURP toward bipolar technique and the introduction of new laser techniques, physiological saline (0.9% NaCl) is now used as the irrigation fluid, which leads to a new post-TURP syndrome with a different clinical presentation and treatment compared to the previous one.