benign prostatic hyperplasia
2 articles
Benign prostatic hyperplasia - etiology, clinical features and management. Historical and contemporary aspects
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.
Thulium: yttrium-aluminium-garnet laser transurethral vapoenucleation - a new standard in the surgical treatment of large benign prostatic hyperplasia
Introduction
According to the current recommendations of the European Association of Urology and the International Society of Urology, open simple prostatectomy is the reference standard in the surgical treatment of benign prostatic hyperplasia of large size (>80 ml). Extended trauma and a high complication rate reduce the chances to use this method. In this context, several minimally invasive laser surgical treatment techniques have been proposed in order to provide an optimal treatment to patients. Transurethral endoscopic vapoenucleation of the prostate using laser energy is a new concept in endourological surgery.
Material and methods
Between September 2019 and December 2019, 93 patients with benign prostatic hyperplasia underwent surgical treatment. Two surgical methods were applied: transurethral Thulium:YAG laser prostate vapoenucleation (45 patients) and open simple prostatectomy (48 patients). All patients were evaluated preoperatively and postoperatively (3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score and International Erectile Function Index, physical examination and digital rectal examination, prostate specific antigen assessment, transrectal prostate ultrasound examination and assessment of residual urine volume, uroflowmetry. Postoperative complications were recorded according to the Clavien-Dindo classification, 2004. The inclusion criteria were total prostate volume ≥80 cm3, age ≤80 years, residual urine volume ≥70 ml, Qmax ≤10 ml/s.
Results
Transurethral Thulium:YAG laser vaponucleation of prostate has proven a high surgical efficiency level. The baseline urodynamic and ultrasonographic indicators after transurethral vapoenucleation at 6 months postoperatively were similar to those in the control group (open simple prostatectomy). The duration of recovery of patients after classical surgery was significantly longer. At the same time, the rate of postoperative complications after prostate vapoenucleation was lower. Patients in the ThuVEP group did not require blood transfusions.
Conclusions
According to obtained results, we can assume that transurethral vapoenucleation of the prostate with laser energy will soon become a new „gold standard” in the surgical treatment of large benign prostate hyperplasia.