Alternatives to prostatectomy.

The danger of the treatments described are that patients may be treated without referral to a urologist. Investigations to determine whether genuine obstruction is the cause of their symptoms may not be performed and follow-up to exclude the side effects of their outflow obstruction or indeed their treatment may not be carried out. In addition, in cases where digital palpation does not alert the clinician to the possibility of prostatic malignancy, the loss of specimens for histological interpretation may lead to missed diagnoses. In summary, the alternatives to prostatectomy are still limited. Hormonal manipulation, hyperthermia and prostatic dilatation using the smaller balloons have no role at present in symptomatic patients. The role of larger balloons has still to be determined. Alpha blockade, while achieving relief in the short-term, still requires long-term objective follow-up studies in patients with urodynamically proven obstruction to assess patient compliance and the effects of treatment before it can be recommended as a long-term alternative. Similar information is also required before the efficacy of hyperthermia in patients with retention can be determined. For high risk patients with a limited life expectancy who present with retention of urine, prostatic stents may have a role, but once again long-term follow-up data are required before this treatment can be advocated in fitter or symptomatic patients.