Office-based prostate procedures

The surgical treatment of symptoms secondary to BPH continues to evolve within the dynamics of current health care trends and economics. Medicare reimbursement schedules have changed over the past few years; hospital procedures have decreased whereas reimbursement has increased for office-based procedures [67]. Office-based procedures (described previously) and newer modalities will continue to find a place in the treatment of BPH. TURP is the gold standard with which all other modalities long will be compared. The benefits of these minimally invasive treatments need to be weighed against the limitations of each treatment modality. Many of the available treatments have a decreased efficacy compared with TURP and some are associated with significant irritative voiding symptoms after treatment. The decreased risks associated with these treatments, however, such as bleeding, hyponatremia, and anesthetic risks, along with their use in outpatient settings, make them appealing to surgeons and patients. Furthermore, these alternate treatment options significantly expand urologists' armamentarium for the treatment of BPH. Being knowledgeable of the available treatment modalities and their advantages and inadequacies is vital in today's urologic practices. Finally, TRUS of the prostate will remain a crucial part of urologists' office-based practice.