Benignes Prostatasyndrom

Reich, Oliver; Seitz, Michael; Gratzke, Christian; Schlenker, Boris; Walther, Sebastian; Stief, Christian G.

doi:10.1007/s00120-009-2183-1

Cited by 21 publications

(4 citation statements)

References 103 publications

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“…Of all surgical treatments, monopolar transurethral resection of the prostate (TURP), in which the enlarged prostate tissue is resected piece by piece using a monopolar electrode, has been the preferred method since the 1970s. It can substantially improve the maximal flow rate (Qmax), urinary symptoms (based on the international prostate symptom score (IPSS)), and health related quality of life, with long term efficacy compared with drugs or other minimally invasive treatments 45. However, monopolar TURP is a risky procedure because of the likelihood of severe complications such as massive bleeding or transurethral resection syndrome 6.…”

Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis

Huang

Tsai

Tseng

et al. 2019

BMJ

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Objective To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. Design Systematic review and network meta-analysis of randomised controlled trials. Data sources A comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019. Study selection Randomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications. Data extraction and synthesis Two independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated. Results 109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (−0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (−1.90 (−5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference −1.00 (−2.41 to 0.40)), bipolar enucleation (0.87 (−1.80 to 0.07)), and holmium laser enucleation (−0.84 (−1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (−1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes. Conclusion Eight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods. Study registration CRD42018099583.

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Section: Introductionmentioning

confidence: 99%

Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis

Huang

Tsai

Tseng

et al. 2019

BMJ

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“…Patients with benign prostatic hyperplasia (BPH) who do not respond to medical treatment often undergo transurethral resection of the prostate (TURP), the gold standard for surgical treatment [ 1 ]. The safety and efficacy of TURP have been proven and validated [ 2 ]. However, it can result in perioperative bleeding, urinary incontinence, retrograde ejaculation, transurethral resection (TUR) syndrome, and erectile dysfunction [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Two Weeks of Treatment with Dutasteride on Bleeding after Transurethral Resection of the Prostate

Kim

Jeong

Park

et al. 2015

World J Mens Health

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PurposeDutasteride affects the prostate by reducing intraprostatic dihydrotestosterone and prostate tissue vascularity. We evaluated the effect of pretreatment with dutasteride for two weeks on perioperative and postoperative bleeding during transurethral resection of the prostate (TURP).Materials and MethodsEighty-three patients who had benign prostatic hyperplasia together with the criteria for eligibility for TURP were included. The dutasteride group consisted of 40 patients who were treated with dutasteride (0.5 mg/d) for two weeks before surgery, and the control group consisted of 43 patients who did not receive dutasteride. Blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before, immediately after, and 24 hours after surgery. We also measured the durations of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization.ResultsLower mean blood loss was observed in the dutasteride group than the control group immediately after and 24 hours after surgery (ΔHb=0.65±1.27 g/dL vs. 1.16±0.73 g/dL, 1.30±1.00 g/dL vs. 1.86±1.05 g/dL respectively, p=0.019, p=0.011; ΔHct=1.89%±3.83% vs. 3.47%±2.09%, 3.69%±2.95% vs. 5.39%±3.23% respectively, p=0.016, p=0.011). In addition, there were fewer days of indwelling urethral catheter use (2.95±1.02 d vs. 3.92±1.14 d, p=0.000), continuous saline bladder irrigation (1.81±1.08 d vs. 2.36±1.06 d, p=0.016), and hospitalization after TURP (3.95±1.09 d vs. 4.76±1.19 d, p=0.001) in the dutasteride group.ConclusionsPreoperative treatment with dutasteride for two weeks before TURP reduces surgical bleeding and length of hospitalization after TURP. This pretreatment can be used to decrease surgical bleeding associated with TURP.

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“…Various forms of surgical treatment for BPH are available today, including conventional techniques, such as transurethral resection of the prostate (TURP), a modified version of this technique, and minimally invasive options (e.g., urethral microwave therapy (TUMT) and laser, electrode, transurethral thermal ablation-assisted techniques) [ 26 ]. In comparison with TURP, laser-based methods decrease short-term complications.…”

Section: Medical Therapy Of Bphmentioning

confidence: 99%

Treatment of Benign Prostatic Hyperplasia by Natural Drugs

et al. 2021

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Benign prostatic hyperplasia (BPH) is one of the most common urinary diseases affecting men, generally after the age of 50. The prevalence of this multifactorial disease increases with age. With aging, the plasma level of testosterone decreases, as well as the testosterone/estrogen ratio, resulting in increased estrogen activity, which may facilitate the hyperplasia of the prostate cells. Another theory focuses on dihydrotestosterone (DHT) and the activity of the enzyme 5α-reductase, which converts testosterone to DHT. In older men, the activity of this enzyme increases, leading to a decreased testosterone/DHT ratio. DHT may promote prostate cell growth, resulting in hyperplasia. Some medicinal plants and their compounds act by modulating this enzyme, and have the above-mentioned targets. This review focuses on herbal drugs that are most widely used in the treatment of BPH, including pumpkin seed, willow herb, tomato, maritime pine bark, Pygeum africanum bark, rye pollen, saw palmetto fruit, and nettle root, highlighting the latest results of preclinical and clinical studies, as well as safety issues. In addition, the pharmaceutical care and other therapeutic options of BPH, including pharmacotherapy and surgical options, are discussed, summarizing and comparing the advantages and disadvantages of each therapy.

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Benignes Prostatasyndrom

Cited by 21 publications

References 103 publications

Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis

Comparative efficacy and safety of new surgical treatments for benign prostatic hyperplasia: systematic review and network meta-analysis

The Effect of Two Weeks of Treatment with Dutasteride on Bleeding after Transurethral Resection of the Prostate

Treatment of Benign Prostatic Hyperplasia by Natural Drugs

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