Monopolar TURP (M-TURP) has dominated surgical treatment of LUTS due to BPH (LUTS-BPH) for >70 years. The increasing LUTS-BPH prevalence in an ageing population and relatively high TURP associated morbidity  spurred the development of surgical alternatives including transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA), interstitial laser coagulation, visual laser ablation, KTP photoselective laser vaporization, Holmium laser ablation, Holmium laser enucleation and Thulium laser ablation, resection or enucleation. Through this technologically diverse era, M-TURP remained the enduring reference standard because of the availability of long-term outcome data in large patient numbers treated in academic and community settings. Recent improvements in anaesthetic techniques and surgical instrumentation also reduced immediate and long-term M-TURP complications, favouring its continued use [2,3].
The indications for surgical LUTS-BPH treatment have been transformed in modern practice with increasing use of medical therapies (α-adrenergic antagonists and 5α-reductase inhibitors), either in isolation or combined for larger prostates. LUTS-BPH are now commonly treated with medical monotherapy for rapid effective stabilization or symptom improvement , while only combined therapy can effect prostate size. The most common indication for TURP has shifted from LUTS-BPH (without formal subjective or objective quantification using validated instruments to assess domains of bother or quality of life impact), to moderate-severe LUTS-BPH refractory to medical therapy, coupled with abnormal objective parameters (impaired flow rate and/or increasing residual urine volume), or when BPH-BOO complications arise. A recent retrospective single institution experience review reported that although combined medical therapy (unreported duration) use had increased from 5% to 58%, failed ‘medical therapy’ as an indication for TURP also increased from 36% in 1998 to 87% in 2008, while a worrying increase was seen in hydronephrosis .
This dramatic recent shift to initial LUTS-BPH medical monotherapy, where prostate growth may have continued unchecked for many years longer than in previous decades, raised the issue as to whether there may be knock-on consequences to surgical outcomes. The primary aim of the present study was to determine the preoperative prostate volume (PV) and resected prostate weight reported in contemporary TURP series, comparing them with the large reference cohort studies of Borboroglu et al.  and Mebust et al. , 10 and 20 years ago respectively (i.e. had prostates ‘grown’ during the medical paradigm era), as large randomised controlled trials (RCTs) during this time were lacking. Secondary aims were to compare postoperative outcomes of contemporary M-TURP with those two studies. Where possible, data was compared with Madersbacher and Marberger  who, using similar methods, extracted data on 1480 patients who had undergone TURP as part of an RCT during the period 1986–1998. The objective of their review was to determine the current status of TURP, compared with previous observational studies, but with particular reference to less invasive techniques, e.g. TUMT and TUNA.