HBP Surgery Techniques: A Guide for Doctors
“Previously, in the HBP, our approach was vrey basic,” explains professor Souhil Lebdai, head of the AFU’s male urinary disorders committee. “The choice between the three surgical treatment options – incision cervico-prostatique (ICP), transurethral resection of the prostate (TURP) and open prostatectomy (OP) - was based on prostate volume.” But recently, therapeutic options have multiplied, with increasingly minimally invasive procedures aimed at reducing morbidity and sequelae. “And now, for a more nuanced approach, other parameters must be integrated into the thinking: sexuality, comorbidities, how the surgery is performed, etc. Thus, in our current reasoning, we have moved from three to at least fifteen clinical profiles.” Moreover, patients tend to prioritize reducing surgical risks, including those related to sexuality, over maximizing improvement in lower urinary tract symptoms (LUTS).
therefore, there are different profiles, requests and medical imperatives, varying according to age.
More Individualization
For Professor Lebdai, the richness and versatility of the therapeutic arsenal meets a need and “each medical situation corresponds to a selection of techniques.”
In broad terms, the 2025 recommendations point towards ICP for patients with moderate to severe LUTS with a prostate volume of less than 30 cc, without a median lobe. TURP is more recommended in cases of moderate to severe LUTS with a prostate volume between 30 and 80 cc; an alternative being prostatic photovaporization (PVP) with a Greenlight laser (which is offered promptly to patients at hemorrhagic risk). Endoscopic enucleation of the prostate can also be proposed in this indication, with HoLEP as the reference technique. OP remains preferred in cases of prostate volume greater than 80 cc in centers that do not have an endoscopic enucleation technique.For men with moderate to severe LUTS, wanting less invasive treatment and accepting some residual symptoms, several options are available.