Is Enucleation Technologies the best available now for surgical treatment of LUTS/BPO
We are now in an era where many believe that Enucleation Technologies, Monopolar, Bipolar, Lasers are the way to go about when considering Surgical options for LUTs/BPO. There are more new options that are being touted as probably better or equal options for even these Enucleation methods. But these newer options need more evaluations before being touted as the way to go about for the surgical Treatment for LUTS/BPO.
Recently we did have 3 Webinars addressing this subject from India and abroad. These webinars addressed Enucleation Technologies barring one where Aquablation was also mentioned. Each of the proponents of a particular technology tried to sell their views. But it is nice to remember that inspite of their preference, the famous quotation ‘Rose is a Rose is a Rose’ (interpreted as ‘things are what they are’ is worth remembering). It is also worth remembering that it is the man behind the technology that is more important than technology. Huxley stated a few years ago that a patient should go to the surgeon he trusts and not for technology he can offer.
A recent study published by Hashim Hashim, Paul Abrams et al (2020) on ‘Thulium Laser Vapo-resection vs TURP for LUTS or Urinary Retention UNBLOCS Trial RCT’ concluded by stating ‘TURP and ThuVARP were equivalent for urinary symptom improvement (IPSS) 12-months post surgery, and TURP was superior for Qmax. Anticipated laser benefits for ThuVARP of reduced hospital stay and complications were not observed’. This is concerning Vaporesection and not enucleation.
Stamey as early as 1994 stated that ‘it is sad but true that TURP will soon be relegated to History’ but it has continued to stay alive and kicking and many are still practicing it with vigour. The results of newer technologies are compared with TURP even now. If TURP was not such an effective tool as being proposed now, why then should the results of newer technologies compared with TURP.
In this context I would like to provide the link for the original article of Yasunori Hiraoka (1983) who gave us the concept of Enucleation of prostate. Those who like historical aspects of Urology will like this article.
It is our common practice to praise all that is new punching holes into existing technologies as inferior. Comparing Surgical Technologies used for Urological ailments are difficult unlike medical therapies. The main problems encountered at such comparison of surgical techniques are Surgeon Oriented and his expertise will go a long way in predicting the outcome.
All techniques available are beneficial if used with caution.
With warm regards,