Three-year experience of treatment of patients with benign prostatic hyperplasia: from open surgery to a bipolar enucleation

2018 ◽  
pp. 41-49
Author(s):  
Н.В. Плакса
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Postoperative Bleeding ◽  
Total Duration ◽  
Statistical Processing ◽  
Clinical Effectiveness ◽  
Prostatic Hyperplasia ◽  
New Method ◽  
Significance Level ◽  
Surgical Methods ◽  
Duration Of Hospitalization

В статье представлен опыт внедрения нового метода лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) - трансуретральной биполярной энуклеации простаты (ТУЭБ) в арсенал хирургических методов урологического отделения "Клинической больницы "РЖД - Медицина" г. Саратов. Статистические данные по контролю были получены ретроспективным методом из архива историй болезни. Статистическую обработку результатов исследования проводили при помощи параметрического критерия t Стьюдента. Различия показателей считались достоверными при уровне значимости р ≤ 0,05. Анализ общих операционных результатов и клинической эффективности нового метода (89 чел.) проведен в сравнении с ретроспективными данными по методу открытой простатэктомии (ОПЭ - 91 чел.), ранее применявшегося в отделении для лечения пациентов данного профиля. Установлено, что применение ТУЭБ вместо ОПЭ при средних и больших объемах ДГПЖ позволяет в 2-3 раза снизить кровопотерю во время операции, сроки послеоперационного дренирования мочевого пузыря и общую продолжительность госпитализации при минимальном количестве интра- и послеоперационных кровотечений и при отсутствии осложнений инфекционно-воспалительного характера. Полученные результаты свидетельствуют о перспективности применения ТУЭБ вместо травматичной ОПЭ, так как это позволяет оптимизировать хирургические результаты и экономические показатели лечения ДГПЖ. The article presents the experience of the introduction of a new method of treatment of benign prostatic hyperplasia (BPH) - transurethral bipolar prostate enucleation (TUEB) in a set of surgical methods of the urological Department of the "Clinical hospital "Russian Railways - Medicine" of Saratov. Statistical data on control were obtained by retrospective method from the archive of medical records. Statistical processing of the results of the study was carried out using the parametric t-student test. The differences were considered significant at the significance level p ≤ 0.05. The analysis of the general operating results and clinical effectiveness of the new method (89 people) was carried out in comparison with the retrospective data on the method of open prostatectomy (OPE - 91 people), previously used in the Department for the treatment of patients of this profile. It was found that the use instead of OPE for medium and large volumes of BPH allows 2-3 times to reduce blood loss during surgery, the timing of postoperative drainage of the bladder and the total duration of hospitalization with a minimum amount of intra- and postoperative bleeding and in the absence of complications of infectious and inflammatory nature. The results indicate the prospects instead of traumatic OPE, as it allows to optimize the surgical results and economic indicators of treatment of BPH.

The first experience of bipolar transurethral operations in surgery of benign prostatic hyperplasia

2018 ◽  
pp. 10-20
Author(s):  
Н.А. Глотов ◽  
Н.Е. Соколов ◽  
Ю.Б. Смоляков
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostatic Hyperplasia ◽  
Medium Term ◽  
Significance Level ◽  
The Road ◽  
Surgical Methods ◽  
The Comparative Study ◽  
Endoscopic Methods ◽  
Qualitative Characteristics

Представлены результаты внедрения в хирургическую практику урологического отделения Дорожной клинической больницы г. Ярославль биполярной техники трансуретральной резекции (БТУР) и энуклеации простаты (ТУЭБ) для лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) средних и больших размеров. В сравнительное исследование включено 164 пациента, разделенных по методам операции на 2 основные группы (ТУЭБ - 33 человека, БТУР - 49) и 2 контрольные (открытая простатэктомия - ОПЭ - 38 и монополярная ТУР - 44). Для новых эндоскопических методов установлено значимое снижение объема кровопотери, частоты геморрагических осложнений, сроков послеоперационной катетеризации и госпитализации. Для количественной оценки различий средних и относительных показателей использо-вали непараметрический критерий Манна-Уитни, оценка качественных признаков проводилась с применением критерия Пирсона (χ2), уровень значимости различий для исследования выбран р ≤ 0,05. Анализ послеоперационной динамики клинических показателей в среднесрочной перспективе показал сходную радикальность и эффектив-ность сравниваемых методов. Установленные меньшая инвазивность, большая безопасность и лучшая переносимость биполярных эндоскопических операций демонстрируют перспективность их внедрения взамен бывших стандартных хирургических методов, что позволит повысить качество оперативного лечения и сократить затраты стационара. The results of the introduction into surgical practice of the urological Department of the road clinical hospital of Yaroslavl bipolar technique of transurethral resection (BTTR) and enucleation of the prostate (EOTP) for the treatment of benign prostatic hyperplasia (BPH) of medium and large sizes are presented. The comparative study included 164 patients, divided by the methods of surgery into 2 main groups (EOTP - 33 people, BTTR - 49) and 2 control (open prostatectomy - OPE - 38 and monopolar TTR - 44). For new endoscopic methods, a significant reduction in the volume of blood loss, the frequency of hemorrhagic complications, the timing of postoperative catheterization and hospitalization was established. Nonparametric Mann-Whitney test was used to quantify the differences in mean and relative indicators, qualitative characteristics were evaluated using Pearson test (χ2), the significance level of the differences for the study was chosen p ≤ 0.05. Analysis of postoperative dynamics of clinical parameters in the medium term showed similar radicality and effectiveness of the compared methods. The lower invasiveness, greater safety and better tolerability of bipolar endoscopic operations demonstrate the prospects of their implementation instead of the former standard surgical methods, which will improve the quality of surgical treatment and reduce the costs of the hospital.

Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Blood Loss ◽  
Endoscopic Surgery ◽  
Transurethral Resection ◽  
Operating Time ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

Prevention system and medical support for patients with benign prostatic hyperplasia

2021 ◽  
pp. 18-27
Author(s):  
Egor Aleksandrovich Perevezentsev ◽  
Nadezhda Ilyinichna Gurvich ◽  
Tatyana Andreevna Agapova
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Support System ◽  
Primary Care Physicians ◽  
Prostatic Hyperplasia ◽  
Weak Continuity ◽  
Medical Support ◽  
Male Population ◽  
Minimally Invasive Surgical ◽  
Surgical Methods ◽  
High Level

The article presents an analysis of the current state of the prevention and medical support system for patients with benign prostatic hyperplasia. The urgency of the problem is determined by the significant influence of benign prostatic hyperplasia (BPH) on the quality of life of the male population. The identified shortcomings of the prevention and medical support system (low rates of referral and awareness of the population, insufficiently high level of urological training of primary care physicians, weak continuity between outpatient clinics, etc.) indicate the need for changes in the system of urological care for patients with BPH. The combined use of effective preventive measures and minimally invasive surgical methods for treating BPH increases the efficiency of outpatient and inpatient institutions.

Holmium laser resection of the prostate: Preliminary results of a new method for the treatment of benign prostatic hyperplasia

Urology ◽  
1996 ◽  
Vol 47 (1) ◽  
pp. 48-51 ◽  
Author(s):  
Peter J. Gilling ◽  
Carol B. Cass ◽  
Michael D. Cresswell ◽  
Mark R. Fraundorfer
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostatic Hyperplasia ◽  
New Method ◽  
Holmium Laser ◽  
Laser Resection ◽  
Preliminary Results

scholarly journals Prostatic Artery Embolization for Benign Prostatic Hyperplasia Treatment: A Russian Multicenter Study in More Than 1,000 Treated Patients

2020 ◽  
Vol 14 (3) ◽  
pp. 155798832092391
Author(s):  
Armais Kamalov ◽  
Sergei Kapranov ◽  
Alexander Neymark ◽  
Dmitry Kurbatov ◽  
Boris Neymark ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostate Gland ◽  
Prostatic Hyperplasia ◽  
Urethral Strictures ◽  
Minimally Invasive Surgical ◽  
Surgical Methods ◽  
Superselective Embolization ◽  
Postembolization Syndrome ◽  
Observation Period

Benign prostatic hyperplasia (BPH) is one of the most common diseases of the genitourinary system. The prevalence of BPH increases in men with advancing age. While transurethral resection of the prostate gland entails complications such as retrograde ejaculation, urinary incontinence, hematuria, urethral strictures, bladder neck sclerosis, and other adverse events, it is necessary to apply minimally invasive surgical methods such as superselective embolization of the prostatic arteries (PAE), particularly Proximal Embolization First Then Distal Embolization (PErFecTED). The data from 1,015 BPH patients who underwent endovascular surgery demonstrate the benefits of PErFecTED treatment during 24 months after surgery. Both Quality of Life score and International Prostate Symptom Score were around three times better in the PErFecTED group and remained stable during the entire observation period. However, the technique needs to be improved due to the high risk of postembolization syndrome.

scholarly journals MODERN METHODS OF ENDOSCOPIC ENUCLEATION OF BENIGN PROSTATIC HYPERPLASIA AND PROSPECTS FOR THEIR MODIFICATION

2021 ◽  
pp. 20-29
Author(s):  
E. N. Bolgov ◽  
F. A. Sevryukov ◽  
V. V. Zhezdrin ◽  
R. N. Bobrovsky ◽  
M. A. Volodin
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Laser Energy ◽  
Low Frequency ◽  
Complete Removal ◽  
Infectious Complications ◽  
Prostatic Hyperplasia ◽  
Anatomical Landmarks ◽  
Surgical Methods ◽  
Endoscopic Enucleation

The disadvantage of bipolar and holmium enucleation in transurethral surgery of benign prostatic hyperplasia (BPH) is the frequent postoperative urination disorders. To increase the effectiveness of surgical treatment, a modification of the surgical technique is necessary.Objective: to compare the perioperative results of endosurgical treatment of large sized BPH using transurethral bipolar (TUEB), laser (HoLEP) and modified laser prostate enucleation (HoLEP-M) methods. Patients and methods: A randomized prospective study was conducted according to the results of surgical treatment of 1104 patients with BPH with a volume of 80 to 350 cm3, divided by methods of endoscopic enucleation of the prostate. A mod-ification of the HoLEP technique was to optimize access to the surgical site with the designation of new anatomical landmarks.Results: Comparison of surgical methods showed their equivalence in the volume of removed tissue, the low frequency of hemorrhagic and infectious complications, the dynamics of urological indicators in the delayed period. TUEB has the least parameters for the time of surgical intervention (98.2 ± 2.24 min.), the vol-ume of blood loss (65.5 ± 1.83 ml), the terms of postoperative catheterization of the bladder (2.0 ± 0.32 days), and the days of hospitalization (3.2 ± 0.40 days). The safety of laser methods is higher than TUEB, during which 3.1% of closed perforations of the prostatic capsule and bladder were observed (versus 0.8-1.5% with laser methods). Modification of the HoLEP technique allows reducing the frequency of late dysuric disorders by 2-3 times, urinary incontinence by 3.4-4 times, cicatricial complications by 1.7-2 times.Conclusion: Bipolar and laser methods of transurethral enucleation of the prostate of large sizes are comparable by criteria of complete removal of prostatic tissue, effectiveness and tolerability in patients with thrombohemorrhagic risk. In terms of the frequency of intraoperative injuries, the safety of laser methods is higher due to the reduced penetrating ability of laser energy. Modification of surgical access to the prostate preserves the prostatic urethra as much as possible and is a promising measure for the prevention of late obstructive and functional complications of transurethral interventions.

scholarly journals Pathogenetic therapy of benign prostatic hyperplasia and prostatic intraepithelial neoplasia

2020 ◽  
Vol 13 (4) ◽  
pp. 66-74
Author(s):  
S.S. Krasnyak ◽  
◽  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostate Gland ◽  
Intraepithelial Neoplasia ◽  
The Elderly ◽  
Prostatic Intraepithelial Neoplasia ◽  
Prostatic Hyperplasia ◽  
Common Disease ◽  
Phosphodiesterase 5 Inhibitors ◽  
Surgical Methods ◽  
Phosphodiesterase 5

Introduction. Benign prostatic hyperplasia (BPH) is a neoplasm and clinically occurred by progressive enlargement of the prostate. However, prostate neoplasm can also be malignant, which is come out from high-grade prostatic intraepithelial neoplasia (PIN). It is a proven precancerous condition. Purpose. Тo evaluate the data published on September and October 2020 on the prevalence, pathogenesis of BPH and PIN and methods of their treatment. Materials and methods. The search results in scientific databases PubMed, MEDLINE, Embase were analyzed for the queries «BPH», «PIN», «epidemiology of BPH», «pathogenesis», «treatment of PIN». Results. BPH is a very common disease in the elderly population. The pathogenesis of BPH includes age, genetics or hormones disorders, growth factors, inflammation, and lifestyle factors. PIN is the only common precursor of prostatic cancer. The main treatment methods are 5α-reductase inhibitors, phosphodiesterase-5 inhibitors, and surgical methods. In addition, plant active molecules are also widely used in the treatment of BPH and PIN. Conclusions. While 5α-reductase and phosphodiesterase-5 inhibitors treatment, as well as surgical methods have a lot of adverse events and complications, a unique herbal complex Gardaprost was developed, which suppresses hyperplasia of prostate. Curcumin, genistein and epigalocatechin-3- gallate, which are part of the preparation, form a safe agent aimed at combating the growth of the prostate gland in BPH, and also has a significant effect in the prevention of exacerbations of chronic prostatitis and malignancy in patients with PIN.

LASER TECHNOLOGIES IN SURGERY BENEFICIAL PROSTATE HYPERPLASIA

2021 ◽  
pp. 144-153
Author(s):  
Rakhimov S.A. ◽  
Feofilov I.V. ◽  
Arbuzov I.A.
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Transurethral Resection ◽  
Prostate Gland ◽  
Prostatic Hyperplasia ◽  
Prostate Hyperplasia ◽  
Advantages And Disadvantages ◽  
Laser Technologies ◽  
Surgical Methods ◽  
Laser Systems

Benign prostatic hyperplasia is one of the most common diseases in urological practice. The classical method of surgical treatment of benign prostatic hyperplasia is transurethral resection of the prostate gland. However, this operation is accompanied by a fairly large number of postoperative complications and is not recommended for patients with a large prostate volume, with a high cardiovascular risk, and receiving anticoagulant therapy. In recent years, the medical community has been paying close attention to laser technologies. The article provides an overview of the literature on laser methods for the treatment of benign prostatic hyperplasia. Modern laser systems are considered: holmium, thulium, diode, «green» lasers. The advantages and disadvantages of each technique are described. The results of studies of the efficacy and safety of laser surgical methods for the treatment of benign prostatic hyperplasia and their influence on the indicators of urodynamics, symptoms of the disease, and the quality of life of patients are presented. Based on the analysis of scientific literature sources, it was concluded that laser methods of surgical treatment of benign prostatic hyperplasia are clinically effective and safe. Compared with transurethral resection of the prostate, laser technologies can shorten the period of hospitalization and catheterization of patients, have a low number of complications, provide good hemostasis, and can be used regardless of the volume of the gland in patients with concomitant diseases who are taking anticoagulants. Laser methods of surgical treatment of benign prostatic hyperplasia are currently a full-fledged worthy alternative to transurethral resection of the prostate gland. Among the disadvantages of using laser systems are the duration of the operation and the need to train specialists in the technique of surgical intervention.

scholarly journals Actual aspects of the use of thulium laser as a promising method in the treatment of prostatic hyperplasia

2021 ◽  
pp. 579-584
Author(s):  
Arseniy A. Shiryaev ◽  
◽  
Alexander V. Govorov ◽  
Aleksandr O. Vasilyev ◽  
Aleksandr O. Vasilyev ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Recovery Period ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
The Body ◽  
Urinary Flow ◽  
Male Population ◽  
Surgical Interventions ◽  
Minimally Invasive Surgical ◽  
Surgical Methods

Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most widespread and frequent urological problem among men, affecting about a third of the male population of Russia over 50 years of age. Surgical intervention is the most effective method of treating benign prostatic hyperplasia, and about 75,000 surgical interventions are performed annually in Russia. Today, of all available surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected with a monopolar electrode, has been the preferred surgical method since the 1970s. This method of therapy can significantly improve the maximum urinary flow rate (Qmax), reduce obstructive symptoms assessed on the basis of the international questionnaire on the severity (IPSS) and improve the quality of life of patients. However, monopolar TURP is a rather risky procedure due to the possibility of developing serious complications such as massive bleeding or TURP syndrome (water intoxication syndrome of the body). Consequently, practicing urologists all over the world are faced with the urgent task of developing minimally invasive surgical methods of treatment, the results of which would be at least similar to those after monopolar TURP, while with fewer intra- and postoperative complications, side effects and a shorter recovery period for the patient.

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