scholarly journals Comparative evaluation of clinical efficacy, safety, and economic expenses of two endoscopic techniques for treating prostatic hyperplasia in elderly patients

2020 ◽  
Vol 12 (3) ◽  
pp. 41-54
Author(s):  
Kirill S. Peshekhonov ◽  
Eugene S. Shpilenia ◽  
B. K. Komyakov ◽  
Oleg O. Burlaka ◽  
Natalia V. Morozova
Keyword(s):  
Urinary Tract ◽  
Cost Effectiveness ◽  
Surgical Treatment ◽  
Elderly Patients ◽  
Lower Urinary Tract ◽  
Prostatic Hyperplasia ◽  
Urine Flow ◽  
Urinary System ◽  
Surgical Interventions ◽  
Lower Urinary

Introduction. Rapidly developing highly specialized medical care and the emergence of new medical technologies determine the trend in surgical, minimally invasive treatment of patients with lower urinary tract symptoms due to prostatic hyperplasia. Drug therapy in elderly patients with somatic diseases poses a problem of poor compliance due to pronounced side effects caused by a drug. In this group of patients, surgical treatment of prostate hyperplasia is the most preferred solution. A doctors task is to choose the optimal method of surgery which will not only provide a long-term clinical effect, but also will minimize the economic costs of both surgical intervention and the postoperative period. The emergence of various types of energies for enucleating the prostate gland in urological practice has become an attractive alternative to transurethral resection of the prostate (TURP). However, when choosing surgical endoscopic intervention, it is important to consider the economic factor, which is considered to be a crucial problem in the medical care in Russia. Modern treatment options can not only prevent serious complications, and additional surgical interventions, but also improve the quality of patients lives. However, the introduction of new technologies is impossible without taking into account data on their cost-effectiveness. Purpose. To compare the results and evaluate cost-effectiveness of two types of BPH endoscopic surgical treatment (bTURP, HOLEP) in elderly patients (60 years old). Materials and methods. The study includes patients who underwent two different methods of endoscopic treatment of HPV (bTURP, HOLEP) from October 2017 to September 2018. The inclusion criteria were the presence of moderate or severe obstructive symptoms of the lower urinary tract, prostate volume 40 cm3, maximum urine flow 15 ml/sec. The exclusion criteria were the presence of cystostomy drainage, oncological process of the urinary system, active inflammatory process of the genitourinary system, previous surgical interventions on the organs of the urinary system, and symptoms of an overactive bladder. In each group of the patients the following indicators were evaluated the international system for the total assessment of prostate diseases (IPSS and QoL), the international index of erectile function, the dynamics of postoperative changes in prostate-specific antigen, the maximum urine flow, the residual volume, safety of the operation, intraoperative and postoperative economic expenses as well as socio-economic consequences. Cost-effectiveness analysis was carried out by calculating the indicators cost-effectiveness, cost-utility, net monetary benefit. 20-year prediction of the results was carried out by building the Markov chain model. Results. 150 patients operated within a year were examined. HOLEP has showed its clinical efficacy before bTURP in terms of the duration of surgery, the volume of tissue removed, the time of postoperative catheterization and the length of hospital stay which was significantly lower in the HOLEP group. However, the economic expenses associated with HOLEP were also higher compared to the bTURP group. Conclusions. Holmium laser enucleation is the preferred method for surgical treatment of prostatic hyperplasia in the prostate of more than 40 cm3, from the point of view of surgical safety, effectiveness, and also the length of the patients recovery period in elderly patients. Moreover, laser operations are considered to be economically reasonable in comorbid patients associated with a minimal risk of complications.

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

2020 ◽  
Vol 8 (1) ◽  
pp. 25-38
Author(s):  
K. S. Peshekhonov ◽  
E. S. Shpilenia ◽  
B. K. Komyakov ◽  
O. O. Burlaka ◽  
M. S. Sargsyan
Keyword(s):  
Urinary Tract ◽  
Surgical Treatment ◽  
Elderly Patients ◽  
Lower Urinary Tract ◽  
Recovery Period ◽  
Specific Antigen ◽  
Urine Volume ◽  
Prostatic Hyperplasia ◽  
Urogenital System ◽  
Lower Urinary

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.

scholarly journals Evaluation of the efficacy and tolerability of combination therapy for lower urinary tract symptoms in patients with chronic prostatitis and benign prostatic hyperplasia

2021 ◽  
Vol 14 (2) ◽  
pp. 37-42
Author(s):  
I.V. Vinogradov ◽  
◽  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Chronic Prostatitis ◽  
Lower Urinary Tract ◽  
Combined Therapy ◽  
Prostatic Hyperplasia ◽  
Urine Flow ◽  
Group I ◽  
Urinary Tract Symptoms ◽  
Lower Urinary

Introduction. Chronic prostatitis (CP) is one of the most common urological diseases; CP often accompanies benign prostatic hyperplasia (BPH). Quite often in patients with CP, obstructive, irritative and urethral symptoms are detected. However, there is simply no effective therapy for CP. Despite the lack of data on the proven effectiveness of herbal medicine in international clinical trials, this treatment for CP and BPH remains popular. Aim. To study clinical efficacy and safety of CHINCH herbal drug in treatment of patients with CP and BPH. Materials and methods. 820 men from 13 clinical centers of the Russian Federation with lower urinary tract symptoms associated with CP and BPH were included in the study. The patients were divided into 2 groups. Group I included 423 patients who were administered a complex therapy with Tamsulosin (0.4 mg, 1 capsule once a day for 2 months) and CHINCH (2 capsules 2 times a day for 2 months). Group II consisted of 397 patients who had only Tamsulosin (0.4 mg, 1 capsule once a day for 2 months). Results. According to uroflowmetry, the patients from the group with combined therapy showed significantly better average values of the maximum urine flow rate (Qmax) at the end of 2 months of the therapy, than the initial values in the group, as well as the values of the monotherapy group (p<0.05). All patients noted an increase in the urine flow rate after a month of taking drugs with an increase in the effect by the end of the program. All patients who were included in the observational program, marked an improvement in the quality of life (QoL). The QоL value in the group I became significantly higher (p <0.05) compared with the initial and intermediate values, as well as with the same values in the monotherapy group. All patients noted that the prescribed therapy was well tolerated. Discussion. The study showed, that both subjective and objective criteria for assessing the disease course improved in patients using our approach of complex therapy for lower urinary tract symptoms, associated with CP and BPH (CHINCH in combination with Tamsulosin). These results indicate that the use of herbal therapy in combination with basic therapy with Tamsulosin is an effective and safe treatment method for lower urinary tract symptoms, caused by CP and BPH. Our results are consistent with the data of other researchers. Conclusions. Combined therapy with an alpha-adrenergic blocker in combination with CHINCH, compared with monotherapy, can help to achieve a faster and more significant result in the relief of lower urinary tract symptoms caused by CP and BPH. The combined therapy allows to achieve a higher level of Qmax, IPSS and QOL values within a month, and by the end of the second month - to enhance this effect. The use of CHINCH is not accompanied by adverse effects and can be administered for a long time to relieve lower urinary tract symptoms in patients with CP and BPH.

scholarly journals Correlation of prostate volume with severity of lower urinary tract symptoms as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Mudi Awaisu ◽  
Muhammed Ahmed ◽  
Ahmad Tijjani Lawal ◽  
Abdullahi Sudi ◽  
Musliu Adetola Tolani ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Flow Rate ◽  
Lower Urinary Tract ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Urine Flow ◽  
Urine Flow Rate ◽  
Urinary Tract Symptoms ◽  
The Mean ◽  
Lower Urinary

Abstract Background The aim of the study is to find the correlation between the prostate volume and severity of lower urinary tract symptoms (LUTS) as measured by international prostate symptoms score and maximum urine flow rate among patients with benign prostatic hyperplasia (BPH). Methods The study was a prospective correlational study conducted between June 2016 and November 2017. A total of 290 patients who presented with LUTS suggestive of BPH and satisfied the inclusion criteria were consecutively recruited. Clinical evaluation including digital rectal examination of the prostate was done. Symptoms severity was assessed using the self-administered international prostate symptoms score (IPSS) questionnaire. Prostate volume was determined by transrectal ultrasound scan, and the urine flow rate was measured using uroflowmeter. Data were analyzed using SPSS version 20.0, and p value < 0.05 was taken to be statistically significant. Results The mean age of the patients was 64.22 ± 9.04 years with a range of 40 to 95 years. Most of the patients had moderate symptoms (55%) on IPSS with the mean IPSS value of 16.41 ± 7.43. The mean Qmax value was 16.55 ± 7.41 ml/s, and the median prostate volume (IQR) was 45.05 (35, 59). There was a positive significant correlation between prostate volume and IPSS (r = 0.179, p = 0.002) and a negative significant correlation between prostate volume and Qmax (r = − 0.176, p = 0.003). Conclusion This study showed a significant correlation between the prostate volume and IPSS, and also between prostate volume and maximum flow rate (Qmax).

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