3 articles
Specialists are currently interested in the method of choice for surgical treatment in patients with enlarged benign prostate hyperplasia (> 80 cm3). The introduction of laser and bipolar technologies for benign prostate hyperplasia surgery has allowed effective treatment regardless of the size of the prostate gland.
During 2020-2021, 65 patients underwent surgical treatment for large benign prostate hyperplasia. Depending on the type of surgical treatment performed, 3 study groups were identified: 22 patients underwent transurethral Thulium:YAG laser prostate vapoenucleation; 21 patients underwent transurethral bipolar prostate enucleation; and 21 patients underwent a simple prostatectomy. All patients were examined before and after surgery (at 3 and 6 months) using the International Prostate Symptom Score, Quality of Life Score, prostate-specific antigen assessment, transrectal prostate ultrasound examination, and uroflowmetry to assess residual urine volume. Postoperative complications were recorded in accordance with the 2004 Clavien-Dindo classification.
There was a significant difference in the mean operative time ranging from 72±19 min (ThuVEP group) vs. 56±10 min (SP group) and 70±15 min (TUEB group), as well as a decrease in hemoglobin levels, viz. 1.2±0.4 g/dl vs. 2.6±1.1 g/dl vs. 1.6±0.5 g/dl (ThuVEP vs. SP vs. TUEB). The catheterization lasted for 2±1 days (ThuVEP) vs. 10±1 days (SP) vs. 3±1 days (TUEB). A significant improvement in Qmax was registered in the ThuVEP group (122.9%) and in the TUEB group (111.7%). However, patients after a simple prostatectomy showed an increase in Qmax of only 94%. The PVR values were reported to be the same. ThuVEP is an effective surgical technique for large BPH patients. The reduced trauma and lower complication rate of ThuVEP, as well as its effectiveness, have confirmed the need for widespread implementation of minimally invasive laser interventions.
The advantages of ThuVEP compared to TUEB and especially to SP are obvious. Thus, the maximum improvement in PVR was obtained in the ThuVEP group and amounted to 84.6%. The Qmax values in this group of patients also showed an excellent +122% increase. Considering the similar postoperative urodynamic results obtained after all types of surgical interventions, which were assessed within the present research (ThuVEP, TUEB, and SP), as well as a significantly lower complication rate (14.27%) found in the ThuVEP group, we consider it rational to use Thulium:YAG laser energy in the treatment of large BPH.
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.
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.
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.
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.
According to specialized literature, prostatic calculi are found in up to 80% of men over the age of 50. Prostatic calculi associated with chronic prostatitis may be closely related to lower urinary tract symptoms (LUTS) and may cause nonspecific symptoms of LUTS. The treatment drug therapy, minimally invasive as well as open surgeries, the number of which is actually decreasing worldwide. This phenomenon is mostly related to the emergence of both
new diagnostic technologies and endourological treatment.
The study included 40 patients with bladder outlet obstruction caused by prostatic calculi due to CNBP, who were diagnosed via a series of clinical and paraclinical investigations. The treatment methods to remove the bladder outlet obstruction included surgical approaches like transurethral resection (TUR) (n = 10 patients) and laser surgery (Ho: YAG) (n = 30 patients). Subsequently, the patients were monitored and monitored at 1 and 3 months.
All included patients in the study complained of difficulty urinating (bladder outlet obstruction and residual urine) underwent endoscopic surgical treatment. 30 patients underwent transurethral resection of the prostate with Ho:YAG laser operating at pulse energy of 2.3 J and a frequency of 18 Hz, with a peak power of 18.4 W. Laser incisions were made at 5 and 7 points of a standard quadrant by local tissue resection and removal of prostate stones. During 3 months of follow-up, the mean IPSS value improved from 23.2±2.57 points to 12.6±0.54 points; QoL also changed from 4.83±0.51 points to 2.23±0.1 points; Qmax shifted from 9.08 ± 1.8 ml/s before surgery to 14.07±1.7 ml/s after surgery; the mean value of residual urine decreased to 94.8±47.4 ml and 34.23±9.82 ml. The other 10 patients with prostate stones due to CNBP underwent another endoscopic method: incision (ITUP) or transurethral resection (TURP). The dynamics of the test findings during the follow-up period: IPSS improved from 22.9±2.42 to 10.7±0.5 points; QoL improved from 5.0±0.66 to 2.1±0.31 points; Qmax changed from 9.34±1.29 ml/s to 15.82±0.44 ml/s after the surgery. The average value of residual urine decreased from 92.9±17.95 ml to 38.9±5.97 ml. A decrease in prostate volume of 15.2 cm3 was also observed, possibly due to partial removal of sclerotic tissue and lithiasis.
Improvement in urodynamic parameters showed that endoscopic surgical treatment of prostate stones is an effective method for eliminating bladder obstruction and helps to restore urination, as well as improving the quality of life.