The gold standard began in the eighteenth century and consisted of a monetary system whereby gold coins did not circulate, but the authorities promised to exchange the currency for a stipulated amount of gold. This system disappeared following the great depression of 1929.
This concept in medicine has been borrowed from economists and is used to describe a technique or procedure, universally recognized as the best available method. Thus, the gold standard is a superior technique to any other alternative, since it results in better results than those obtained with other means and which also serves as a reference to compare new procedures that arise.
Transurethral resection in benign prostatic hyperplasia
If there is one thing that in Urology is the gold standard is the so-called transurethral resection (TUR) for the treatment of benign prostatic hyperplasia. In 1993, coinciding with the appearance of the first visual laser, TS. Stamey, a recognized expert on the subject, said that the prostate TUR had already gone down in history. However, why 20 years later the vast majority of urologists still do it? The answer is simply because it has very low morbidity.
This is not surprising, since the reality is that there are many surgical techniques or instruments that, when described, reached such perfection that they are insurmountable with the passage of time.. For a technique to replace the TUR as the "gold standard", it must be superior in results and have lower morbidity. In addition, it must be technically simple, not more expensive and with a low learning curve.
On the other hand, it has been shown that, with the laser technique , the postoperative irritative symptoms are very pronounced, being able to last even one year after the intervention.. There is also a significant number of publications that show that the number of reinterventions is considerably higher with the laser compared to the TUR, and that it does not even bleed less. The reality is that there is no scientific evidence that has been able to demonstrate the superiority of laser techniques over TUR.
However, the most important thing is that the clinical guidelines, both that of the European Association and the American Association of Urology, affirm that laser techniques are alternative options and that transurethral resection is the treatment of choice, so it calls the attention that in spite of everything, the laser is a technique so demanded by the patients.
Thus, the RTU of course has potential problems that are continually improving, but it certainly remains the gold standard against which all alternative options have to be compared.