Platinum Priority – Editorial Referring to the article published on pp. 1066–1096 of this issue Transurethral Resection of the Prostate for Benign Prostatic Obstruction: Will It Remain the Gold Standard? Hashim Hashim *, Paul Abrams Bristol Urological Institute, Southmead Hospital, Bristol, UK In the United Kingdom, symptomatic benign prostatic obstruction (BPO) affects 2.5 million men, with 44 000 new cases diagnosed annually. Symptomatic BPO is associated with worsening physical role, social functioning, vitality, and mental health [1]. The number of patients with BPO is expected to grow by almost 50% by the year 2025, as it is a disease of older men [2]. Men usually present with lower urinary tract symptoms (LUTS), such as slow and intermit- tent urinary stream, or with acute urinary retention (AUR). LUTS may be treated by watchful waiting or drugs, but many will require prostate surgery. About 25 000 proce- dures are currently performed annually in the United Kingdom, accounting for an expenditure of about £54 million per year. Transurethral resection of the prostate (TURP) has been the gold standard operation for LUTS and AUR and has not changed significantly in 30 yr. TURP is associated with a small but significant risk, with a 30-d mortality of 0.3% and a variety of morbidities including transurethral resection syndrome (1%), which is the absorption of irrigating fluid leading to confusion and collapse, haemorrhage during the operation (transfusion rate: 5%), and subsequent urinary tract infections (20%) [3]. These morbidities result in delayed discharge, in- creased readmissions, and increased primary care utilisa- tion, causing considerable distress to patients and resulting in additional costs for the UK National Health Service (NHS), or any health service around the world. Because the operation is increasingly performed on older men—in the NHS, for example, 41% of the TURP operations in 2010– 2011 were on patients >75 yr—the risks of surgery will likely increase as the population ages. According to the NHS hospital episode statistics, the median stay in hospital after TURP is about 2 d, whereas that of laser prostatectomy is 1 d. In this month’s issue of European Urology, Cornu et al [4] present a systematic review and meta-analysis of random- ised controlled trials (RCTs) evaluating efficacy and safety of transurethral ablative procedures by looking at functional outcomes and complications following transurethral pro- cedures for LUTS resulting from BPO. They analysed 69 RCTs from 1992 to 2013 assessing monopolar TURP (M-TURP), bipolar TURP (B-TURP), holmium laser enucleation of the prostate (HoLEP), and GreenLight photoselective vaporisa- tion of the prostate (PVP). Their conclusion was that B-TURP, HoLEP, and PVP have shown efficacy outcomes comparable with conventional techniques but have the advantage of reduced complication rates. The authors concluded that further studies are needed to provide long-term comparative data and head-to-head comparisons of emerging techniques. In 2010, the UK National Institute for Health and Clinical Excellence (NICE) published guidelines [5] for the manage- ment of LUTS in men (NICE CG 97). NICE recommended that M-TURP, B-TURP, monopolar transurethral vaporisation of the prostate, or HoLEP should be offered to men suffering with voiding LUTS presumed to be secondary to BPO. The 2014 European Association of Urology (EAU) guidelines suggested that B-TURP achieved results comparable to M-TURP in the short and midterm with a more favourable perioperative safety profile. NICE recommended that HoLEP should be performed only in centres that specialise in the technique because a significant learning curve is associated with using it, and appropriate mentored training should be available for EUROPEAN UROLOGY 67 (2015) 1097–1098 available at www.sciencedirect.com journal homepage: www.europeanurology.com DOI of original article: http://dx.doi.org/10.1016/j.eururo.2014.06.017. * Corresponding author. Office 4, Gate 38, Level 3, Pink Atrium, Bristol Urological Institute, Brunel Building, Southmead Hospital, Bristol BS10 5NB, UK. Tel. +44 117 414 0931; Fax: +44 117 414 9474. E-mail address: h.hashim@gmail.com (H. Hashim). http://dx.doi.org/10.1016/j.eururo.2014.12.022 0302-2838/# 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.