Surgical treatment of benign prostatic hyperplasia: modern methods and potentials

Красулин, В. В.; Глухов, В. П.; Vasilev, K.

doi:10.21886/2308-6424-2019-7-2-85-92

Cited by 14 publications

(3 citation statements)

References 33 publications

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“…Also, BPH surgery in recent decades has benefited from mini invasive surgical techniques such as: transurethral vaporization -TUVP being an alternative to TURP/TUIP; Laser enucleation: Nd:YAG, KTP:YAG, with diode, Holmium: YAG; HoLEP; Cryosurgery -bipolar electrocoagulation, intermittent coagulation resection, rotoresection. A dynamic evaluation study 5 years after the application of HoLEP and open transvesical prostatectomy established a promising evolution with the need for follow-up surgeries at a low rate [4,[30][31][32]. However, for prostates with nodules larger than 80-100 g, TURP had a rate of re-surgery rate of 55% and mortality rates of 6% [33,34].…”

Section: Resultsmentioning

confidence: 99%

“…Among the most common prostate pathologies that induce micturition disorders, has an impact on the quality of life, starts from the working age, but with a major impact in old age, are benign prostatic hyperplasia (BPH), chronic prostatitis (PCr) and prostate carcinoma (CP). However, the most important is BPH [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Advances in diagnostic technologies, pharmacological and surgical treatment in recent years have greatly contributed to the optimization of diagnosis and treatment by mini-invasive surgical resolution of obstructive syndrome in BPH [6,12,13]. However, the individualized approach to treatment allows to achieve the optimal result of treatment and improve postoperative quality of life [4,12,14]. The optimization of treatment in BPH and the reduction of the intraoperative and postoperative complication risks remains open, being an ongoing problem, which requires further research.…”

Section: Introductionmentioning

confidence: 99%

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Benign prostatic hyperplasia - etiology, clinical features and management. Historical and contemporary aspects

Bobu¹,

Tanase²,

Zota³

2023

MJHS

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Introduction. Benign prostatic hyperplasia and chronic prostatitis are the most common conditions in men, the frequency of which varies with age. Chronic prostatitis (infectious or inflammatory) has a frequency of 8-35% in patients aged 20-50 years, reaching a maximum of 60-70% in those aged over 50 years. Materials and methods. Materials for the study served the medical literature regarding benign prostatic hyperplasia and chronic inflammation, published in the local and international scientific journals. Scientific databases like Cochrane Library, Medline, Scopus, Medicus, NCBI, PubMed, Google Scholar were used to find the necessary articles. Research methods – analysis, synthesis, systematization, and description. Results. After analyzing the available data, a review of the literature was conducted which highlighted both the strong and weak points of the historical medical approaches to addressing benign prostatic hyperplasia, as well as the ontogenetics and anatomical characteristics of the prostate gland. This included examining the incidence rates, concepts of causation and development, principles of diagnosis and classification of benign prostatic hyperplasia. The review also revealed the pros and cons of using mini-invasive treatment strategies versus traditional transvesical approaches in treating this condition, as well as the ongoing and significant socioeconomic impact in underdeveloped countries. Conclusions. There remains the issue of reducing intra- and post-operative complications after benign prostatic hyperplasia surgery, especially a voluminous one, which imposes itself as a very critical problem in the development of an effective treatment strategy. For the first time, a problem was described by assessing the particularities of some biochemical criteria at local surgical site and in blood serum, histological - at the level of nodular prostatic hyperplasia and at the border of the surgical site. This requires a complex correlational study to assess the biochemical, histological and immunohistochemical parameters, including the evaluation of the associations or coexistence of benign prostatic hyperplasia and chronic prostatitis.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Benign prostatic hyperplasia - etiology, clinical features and management. Historical and contemporary aspects

Bobu¹,

Tanase²,

Zota³

2023

MJHS

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Endoscopic Treatment of Prostatic Hyperplasia in Elderly Patients: A Comparative Analysis of Resection and Enucleation Technique

et al. 2020

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Introduction. The pharmacological market, which is rapidly developing, as well as the appearance of combined forms of drugs, determine the trend in the conservative treatment of patients with symptoms of the lower urinary tract due to benign prostatic hyperplasia (BPH). However, simultaneous administration of drugs from several drug groups, by the patients, who are burdened with concomitant diseases (cardiovascular disease, diabetes) in certain cases, makes surgical treatment of BPH preferable and sometimes the only possible option. In this instance, the doctor’s task is to choose the optimal method of surgery that minimizes the risks of complications and provides a long-term clinical effect. The actively developing technique of endoscopic enucleation of prostate corresponds to the current needs. Various types of energies, which have appeared lately in urological practice for enucleation of the prostate, have become an attractive alternative to transurethral resection of the prostate (TURP). The introduction of a bipolar technology into clinical practice has allowed to significantly expand the use of operations among elderly patients with comorbidities. Laser endourology has gone further in reducing the risks of possible complications. Currently we are witnessing a lack of research, which compares the use of modern methods with bipolar TURP (B-TURP) in elderly patients, i.e. groups with a high risk of intraoperative & postoperative complications.Purpose of the study. To compare the results of various types of BPH endoscopic surgical treatment in elderly patients (> 60 years old).Materials and methods. The study included patients who underwent three different operations treating BPH (B-TURP, B-TUEP, HoLEP) from October 2017 to September 2018. The criteria for inclusion in the study were as follows: the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume > 40 cm3, maximum urine flow <15 ml/s. Exclusion criteria were as follows: the presence of cystostomy drainage, the presence of the oncological process in urinary tract, active inflammatory process of urogenital system, earlier received surgical interventions on the organs of the urinary system. Each group of patients has been assessed on following criteria: International Prostate Symptom Score (IPSS and QoL), international index of erectile function (IIEF-5), the dynamics of postoperative changes in prostate specific antigen (PSA), maximum flow of urine, postvoid residual urine volume, intraoperative and postoperative parameters.Results. 190 patients operated during the year were examined in the current study. Duration of operation, extent of resection, time of postoperative catheterization and duration of hospital stay rates were significantly lower in the HoLEP group. There have been no cases of complications above the 3 level by the Clavien‒Dindo scale.Conclusions. HoLEP is the preferred method of surgical treatment of prostatic hyperplasia over 40 cm3 in terms of surgical safety, efficacy, and the duration of the patient’s recovery period. This method can serve as an alternative to electrosurgical techniques in elderly patients.

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Experience in the use of MOSES technology for endoscopic treatment of benign prostatic hyperplasia

Peshekhonov¹,

Burlaka²,

Шпиленя

et al. 2020

Vestn. urol.

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Introduction. The development of laser technologies in medicine and their introduction into everyday clinical practice determine the trend of using this type of energy in the treatment of patients with lower urinary tract symptoms caused by benign prostatic hyperplasia (BPH). In the last decade, holmium laser enucleation (HoLEP) of the prostate has been claiming to be «the gold standard» in the BPH treatment. The advantages of HoLEP over alternative technologies (transurethral resection, bipolar enucleation) in the BPH treatment have been demonstrated in randomized trials. These advantages include the reduction of the patient's hospital stay, safety of manipulation and high quality of life for the patient after surgery. The use of electrical energy in resection techniques for the BPH treatment in most cases is limited by the prostate volume (80 cm3). A better understanding of the effect of laser radiation and its clinical efficacy has led to increased interest and widespread adoption of laser systems. The constant search and improvement of existing approaches encourages urologists and surgical equipment companies to research new laser systems. One type of improvement is a software update for laser pulse modulation that has been developed to improve the efficiency of laser equipment. For the further development of new laser technologies and widespread use in routine clinical practice, it is necessary to compare them with standard methods of BPH surgical treatment with an assessment of the effectiveness, as well as the pros and cons of the compared methods.Purpose of the study. To evaluate the results of laser endoscopic treatment of patients with prostatic hyperplasia.Materials and methods. The study included 50 patients with prostatic hyperplasia who underwent two different types of surgery — HoLEP (group I; n = 25) and HoLEP with MOSES (HoLEP-M) technology (group II; n = 25). Inclusion criteria were: the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume > 40 cm3, maximum urine flow (Q-max) < 12 ml/sec. Exclusion criteria were: the presence of cystostomy drainage, an oncological process of the urinary system, an active inflammatory process of the genitourinary system, previous surgical interventions on the urinary system. I-PSS, QoL and IIEF questionnaires data, the level of prostate-specific antigen (PSA), the maximum flow of the urine stream (Q-max) and the post-void residual volume were assessed at baseline and 3 months after the operation. The main indicators of the compared methods, the number and nature of complications were studied.Results. Both methods of laser enucleation allow achieving a good functional result with a minimum number of complications. When comparing both methods in the group II of patients who underwent HoLEP-M, there was a statistically significant difference in terms of characteristics: the time of enucleation in group I (HoLEP) — 46.7 ± 15.0 min (31 - 80) vs group II (HoLEP-M) — 38.9 ± 7.6 min (30 - 60) (p = 0.03), but this did not affect the total time of surgery (p = 0.21), the level of haemoglobin postoperative changes in group I (HoLEP) — 7.5 ± 5.4 g/l (2 - 18) vs group II (HoLEP-M) — 5.0 ± 2.9 g/l (2 - 13) (p = 0.04) and irrigation time in the postoperative period, group I (HoLEP) — 17.6 ± 3.6 h (11 - 26) vs group II — 14.0 ± 4.3 h (5 - 21) (p < 0.001). Thus, the results of the study suggest that the HoLEP with the modified pulse MOSES technology has advantages over the standard HoLEP technique. HoLEP-M allows you to perform the enucleation stage faster, with better hemostasis and minimizes the effect of the laser on the surrounding tissues. Complications above level 2 were not observed in both groups according to the Clavien-Dindo scale.Conclusion. HOLEP-M is a safe method of surgical treatment of prostatic hyperplasia from the point of view of surgical safety, efficacy, as well as the duration of the patient's recovery period and can serve as an alternative to the HoLEP standard technique.

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Surgical treatment of benign prostatic hyperplasia: modern methods and potentials

Cited by 14 publications

References 33 publications

Benign prostatic hyperplasia - etiology, clinical features and management. Historical and contemporary aspects

Benign prostatic hyperplasia - etiology, clinical features and management. Historical and contemporary aspects

Endoscopic Treatment of Prostatic Hyperplasia in Elderly Patients: A Comparative Analysis of Resection and Enucleation Technique

Experience in the use of MOSES technology for endoscopic treatment of benign prostatic hyperplasia

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