scholarly journals Comparative Analysis of the Effectiveness of Modern Endoscopic Methods of Treatment of BPH

2021 ◽  
Vol 07 (12) ◽  
Author(s):  
Rakhmonov O.M. ◽  
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Maximum Flow ◽  
Prostatic Hyperplasia ◽  
Ktp Laser ◽  
Advantages And Disadvantages ◽  
Term Efficacy ◽  
Bipolar Energy ◽  
Surgical Treatments

Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most common urological problem among men, affecting about a third of men over the age of 50 Of all surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected piece by piece using a monopolar electrode, has been the standard method since the 1970s. It can significantly improve maximum flow rate (Qmax), urination-related symptoms (based on the International Prostate Symptom Assessment Scale (IPSS)), and health-related quality of life with long-term efficacy compared to medications or other minimally invasive treatments [4]. Since the 2000s, new energy systems for surgery for benign prostatic hyperplasia have rapidly become popular, including systems using bipolar energy and various laser systems such as holmium laser, potassium titanyl phosphate (KTP) laser, thulium laser and diode laser Over the past 10 years, the trend in the surgical treatment of benign prostatic hyperplasia has shifted from monopolar TURP to laser therapy and bipolar TURP. Based on the data on the effectiveness of the HoLEP technique, it becomes clear that HoLEP is ready to replace all these methods as a new standard, based on almost two decades of data that consistently demonstrate its better results and lower complication rate. This review summarizes the available literature by comparing HoLEP and traditional BPH treatments that are widely used and have long-term efficacy data. Despite the fact that there is such a wide arsenal of surgical treatment of BPH, each of these methods has its own advantages and disadvantages. This review article contains a significant portion of the best randomized data directly comparing HoLEP with alternative surgical treatments.

Long-Term Efficacy of Serenoa repens Treatment in Patients with Mild and Moderate Symptomatic Benign Prostatic Hyperplasia

2011 ◽  
Vol 86 (3) ◽  
pp. 284-289 ◽  
Author(s):  
Ioanel Sinescu ◽  
Petrisor Geavlete ◽  
Razvan Multescu ◽  
Constantin Gangu ◽  
Florin Miclea ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostatic Hyperplasia ◽  
Serenoa Repens ◽  
Symptomatic Benign Prostatic Hyperplasia ◽  
Term Efficacy

scholarly journals Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alexander S. Somwaru ◽  
Stephen Metting ◽  
Laura M. Flisnik ◽  
Michael G. Nellamattathil ◽  
Arjun Sharma ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Term Efficacy ◽  
Urinary Tract Symptoms ◽  
Surgical Treatments ◽  
Lower Urinary

Abstract Background Patients with severe lower urinary tract symptoms (LUTS) from giant prostatic hyperplasia (GPH): prostate volume greater than 200 mL that do not respond to medical therapy may not be eligible for surgical treatments due to morbidities, technical challenges, and patient preference. This retrospective investigation examined the long-term efficacy and safety of prostatic arterial embolization (PAE) as a treatment option for severe LUTS due to GPH in a large patient cohort. Methods Of 529 patients who underwent PAE between January 2016 and January 2020, 72 patients had severe LUTS from GPH and were retrospectively evaluated. PAE was performed with two embolic agents in sequence: 100–250 μm particles followed by 2 mm and 3 mm coils. Clinical assessment was performed with international prostate symptoms score (IPSS), quality of life (QoL), peak flow rate (Qmax), post-void residual volume (PVR), and prostate specific antigen (PSA) measurements before and 12 months and 24 months after PAE. Prostate volume (PV) was measured by multiparametric magnetic resonance (MR) imaging before and 12 months and 24 months after PAE. Results Patients with severe LUTS from GPH experienced significant clinical improvements in IPSS, QoL, Qmax, PVR, PSA, and PV at 12 months and 24 months after PAE. Mean IPSS decreased from 26.5 to 18.0 (P < 0.01) to 10.5 (P < 0.01). Mean QoL decreased from 6.0 to 4.0 (P < 0.01) to 2.0 (P < 0.01). Mean Qmax increased from 8.0 to 14 mL/s (P < 0.01) to 18 mL/s (P < 0.01). Mean PVR decreased from 198.0 to 152.0 mL (P < 0.01) to 90 mL (P < 0.01). Mean PV decreased from 303.0 mL to 258.0 mL (P < 0.01) to 209.0 mL (P < 0.01). Mean PSA decreased from 11.2 ng/mL to 9.5 ng/mL (P < 0.05) to 7.9 ng/mL (P < 0.05). No major complications occurred. Conclusions PAE is a safe treatment with long term efficacy for severe LUTS from GPH. PAE may be a viable therapeutic option for patients with severe LUTS from GPH whom fail medical therapy and are not candidates for surgical treatments.

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

BMJ ◽  
2019 ◽  
pp. l5919 ◽  
Author(s):  
Shi-Wei Huang ◽  
Chung-You Tsai ◽  
Chi-Shin Tseng ◽  
Ming-Chieh Shih ◽  
Yi-Chun Yeh ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Diode Laser ◽  
Meta Analysis ◽  
Prostatic Hyperplasia ◽  
Efficacy And Safety ◽  
Laser Enucleation ◽  
Randomised Controlled ◽  
Surgical Treatments ◽  
Holmium Laser Enucleation

Abstract 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.

Polymorphisms in the alpha1A-adrenoceptor gene do not modify the short- and long-term efficacy of alpha1-adrenoceptor antagonists in the treatment of benign prostatic hyperplasia

2006 ◽  
Vol 97 (4) ◽  
pp. 852-855 ◽  
Author(s):  
CHAIDIR A. MOCHTAR ◽  
WIJNAND LAAN ◽  
KJELD P. VAN HOUWELINGEN ◽  
BARBARA FRANKE ◽  
JEAN J.M.C.H. DE LA ROSETTE ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostatic Hyperplasia ◽  
Term Efficacy ◽  
Short And Long Term

scholarly journals Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia

2020 ◽  
Author(s):  
Alexander S. Somwaru ◽  
Stephen Metting ◽  
Laura M. Flisnik ◽  
Venkat S. Katabathina
Keyword(s):  
Urinary Tract ◽  
Treatment Option ◽  
Lower Urinary Tract ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Term Efficacy ◽  
Urinary Tract Symptoms ◽  
Surgical Treatments ◽  
Lower Urinary

Abstract Background Patients with severe lower urinary tract symptoms (LUTS) from giant prostatic hyperplasia (GPH): prostate volume larger than 200 mL that do not respond to medical therapy may not be eligible for surgical treatments due to morbidities, technical challenges, and patient preference. This retrospective study examined the safety and long-term efficacy of prostatic arterial embolization (PAE) as a treatment option for severe LUTS due to GPH in a large cohort of patients. Methods 72 patients with GPH and severe LUTS who underwent PAE were retrospectively evaluated. PAE was performed bilaterally with two embolic agents in sequence: 100 µm to 250 µm embolic particles followed by 2 mm and 3 mm coils. Clinical assessment was performed by collecting international prostate symptoms score (IPSS), quality of life (QoL), and post-void residual volume (PVR) before PAE and 12 months and 24 months after PAE. Prostate volume (PV) was measured by multiparametric magnetic resonance (MR) imaging before PAE and 12 months and 24 months after PAE. Results Patients with severe LUTS from GPH experienced significant clinical improvements in IPSS, QoL, PVR, and PV at 12 months and 24 months after PAE. Mean IPSS decreased from 26.5 to 18.0 (P < .0.01) at 12 months and to 10.5 (P < .0.01) at 24 months. Mean QoL decreased from 6.0 to 4.0 (P < 0.01) at 12 months and to 2.0 (P < 0.01) at 24 months. Mean PVR decreased from 198.0 mL to 152.0 mL (P < 0.01) at 12 months and to 90 mL (P < 0.01) at 24 months. Mean PV decreased from 303.0 mL to 258.0 mL (P < 0.01) at 12 months and to 209.0 mL (P < 0.01) at 24 months. There were no major complications. Conclusions PAE is a safe treatment option with long term efficacy in patients with severe LUTS due to GPH. PAE may be a viable therapeutic option for patients with severe LUTS from GPH whom fail medical therapy and are not candidates for surgical treatments.

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.

Doxazosin for Benign Prostatic Hyperplasia: Long-term Efficacy and Safety in Hypertensive and Normotensive Patients

1997 ◽  
Vol 157 (2) ◽  
pp. 525-530 ◽  
Author(s):  
Herbert Lepor ◽  
Steven A. Kaplan ◽  
Ira Klimberg ◽  
David F. Mobley ◽  
Ahmed Fawzy ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Prostatic Hyperplasia ◽  
Efficacy And Safety ◽  
Term Efficacy

scholarly journals Prostate artery embolization has long term efficacy for treatment of severe lower urinary tract symptoms from giant prostatic hyperplasia.

2020 ◽  
Author(s):  
Alexander S. Somwaru ◽  
Stephen Metting ◽  
Laura M. Flisnik ◽  
Michael G. Nellamattathil ◽  
Arjun Sharma ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Lower Urinary Tract Symptoms ◽  
Lower Urinary Tract ◽  
Prostate Volume ◽  
Prostatic Hyperplasia ◽  
Term Efficacy ◽  
Urinary Tract Symptoms ◽  
Surgical Treatments ◽  
Lower Urinary

Abstract Background: Patients with severe lower urinary tract symptoms (LUTS) from giant prostatic hyperplasia (GPH): prostate volume greater than 200 mL that do not respond to medical therapy may not be eligible for surgical treatments due to morbidities, technical challenges, and patient preference. This retrospective investigation examined the long-term efficacy and safety of prostatic arterial embolization (PAE) as a treatment option for severe LUTS due to GPH in a large patient cohort. Methods: Of 529 patients who underwent PAE between January 2016 and January 2020, 72 patients had severe LUTS from GPH and were retrospectively evaluated. PAE was performed with two embolic agents in sequence: 100 μm to 250 μm particles followed by 2 mm and 3 mm coils. Clinical assessment was performed with international prostate symptoms score (IPSS), quality of life (QoL), peak flow rate (Qmax), post-void residual volume (PVR), and prostate specific antigen (PSA) measurements before and 12 months and 24 months after PAE. Prostate volume (PV) was measured by multiparametric magnetic resonance (MR) imaging before and 12 months and 24 months after PAE. Results: Patients with severe LUTS from GPH experienced significant clinical improvements in IPSS, QoL, Qmax, PVR, PSA, and PV at 12 months and 24 months after PAE. Mean IPSS decreased from 26.5 to 18.0 (P < 0.01) to 10.5 (P < 0.01). Mean QoL decreased from 6.0 to 4.0 (P < 0.01) to 2.0 (P < 0.01). Mean Qmax increased from 8.0 mL/sec to 14 mL/sec (P < 0.01) to 18 mL/sec (P < 0.01). Mean PVR decreased from 198.0 mL to 152.0 mL (P < 0.01) to 90 mL (P < 0.01). Mean PV decreased from 303.0 mL to 258.0 mL (P < 0.01) to 209.0 mL (P < 0.01). Mean PSA decreased from 11.2 ng/mL to 9.5 ng/mL (P < 0.05) to 7.9 ng/mL (P < 0.05). No major complications occurred. Conclusions: PAE is a safe treatment with long term efficacy for severe LUTS from GPH. PAE may be a viable therapeutic option for patients with severe LUTS from GPH whom fail medical therapy and are not candidates for surgical treatments.

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