TRANSURETHRAL RESECTION OF THE PROSTATE IN THE MODERN ERA: ADVANCED PATHOPHYSIOLOGY, SURGICAL OPTIMIZATION, OUTCOMES, AND COMPARATIVE EFFECTIVENESS

Abstract

Transurethral resection of the prostate (TURP) remains a benchmark surgical intervention for benign prostatic hyperplasia (BPH) despite the rapid evolution of laser-based and minimally invasive technologies. This advanced review critically evaluates TURP within contemporary urological practice, integrating molecular pathophysiology, patient selection algorithms, surgical optimization strategies, perioperative risk modeling, functional outcomes, complication profiles, long-term durability, cost-effectiveness, and comparative effectiveness data. Evidence from randomized controlled trials and meta-analyses confirms that TURP provides substantial and durable improvements in lower urinary tract symptoms (LUTS) and urinary flow parameters, particularly in prostates between 30–80 mL. While associated with perioperative bleeding risk and ejaculatory dysfunction, refinements such as bipolar energy systems have significantly enhanced safety. TURP continues to represent a reference standard for BPH surgery and remains integral to urological training and global health systems.