Benign prostatic hyperplasia (BPH), also known as benign prostatic hypertrophy, is a histologic diagnosis characterized by proliferation of the. Benign prostatic hyperplasia (BPH) is an enlarged prostate. The prostate goes through two main growth periods as a man ages. The first occurs early in puberty, . It is characterized by the nonmalignant growth of the prostate gland that occurs in most men >40 years of age. The prevalence of BPH, as seen.
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Benign prostatic hyperplasia BPH is a common condition in adult men and its incidence increases progressively with aging. Although the initial treatment is pharmacological, except in specific situations, the tendency of disease progression causes a considerable portion of the patients to require surgical treatment. In this case, there are benina options bebigna today in the therapeutic armamentarium.
Among the options, established techniques, such as open surgery and endoscopic resection using monopolar energy, still prevail in the choice of surgeons because they are more accessible, both from a socioeconomic standpoint in the vast majority of medical services and in terms of training of medical teams.
Each of these techniques has its own peculiarities regarding availability due to cost, learning curve and scientific consolidation in order to achieve recognition as a cutting-edge method in the medical field. The use of bipolar energy in endoscopic resection of the prostate, laser vaporization and enucleation techniques, and videolaparoscopy are examples of new options that have successfully traced this path. Robot-assisted surgery has gained a lot of space in the hlperplasia decade, but it still prosstat to dodge the trade barrier.
Other techniques and technologies will need to pass the test of time to be able to conquer their space in this growing market. It leads to important impacts on physical and mental health. Therapeutic modalities for moderate and severe conditions prowtat with pharmacological treatment and may progress to minimally invasive, laparoscopic, robot-assisted or open surgical alternatives.
Until recently, monopolar transurethral resection of the prostate M-TURP was considered a gold standard for the treatment of prostates with a volume lower than 80 cm 3 due to its effectiveness and low cost. Post-TURP syndrome consists of water intoxication alongside henigna, and can lead to the occurrence of cerebral edema.
B-TURP presents a considerable advantage given the fact that it can be performed with normal saline solution, with excellent results in relation to a greater volume of resection within the same surgical time. There was no statistical difference in the parameters of surgery time, catheterization time, PSA drop, peak flow improvement Peostatoccurrence of urinary retention, and IPSS and quality of life QoL scores.
In a systematic review and meta-analysis evaluating the efficacy Qmax and IPSS and safety of the two techniques, 31 RCTs with 3, patients were included. Regarding safety, the almost non-occurrence of post-TURP syndrome and the low incidence of clot retention, urethral stenosis and bladder neck sclerosis have recently favored a greater use of B-TURP compared with M-TURP, resulting in its recent inclusion as the first line of treatment for enlarged prostates in the current guidelines of the European Association of Urology EAU.
YAG system was released inafter a redesign of the laser generator. With a wavelength of nm using oxyhemoglobin as chromophoreit was initially defined as a high power system HPSwhich had a Beingna output and was often hiperplasua to as photovaporization of the prostate. The new system has significantly reduced laser and operative time. uiperplasia
Hiperplasia prostática benigna –
The number of fibers used during the procedure was significantly reduced using the XPS hiperpoasia, while the total energy used was also lower. The proportion of patients without complications during 24 months was Compared with the first year of the study, few adverse events or retreatment were reported in any of the groups, thus showing the similar efficacy and safety between the two techniques.
Although its short- and medium-term efficacy for small bemigna medium adenomas is well established, there is limited evidence on the use hipefplasia GL-XPS laser in very large prostates. Recently, the safety and efficacy of the GL-XPS system has been demonstrated using a vapoenucleation technique in prostate glands measuring more than mL. The mean surgical time was minutes and an average of three fibers were used per case.
Guidelines for the Treatment of Benign Prostatic Hyperplasia
The mean length of stay and catheterization time was one day. At 12 months, Qmax and post-void residual test PVR improved from The PSA also demonstrated a sustained reduction from 8.
Retreatment was required in only 2. YAG laser operates at 2, nm, with tissue water as the chromophore and its pulsed beam with high-energy concentration results in blisters leading benugna rupture of the prostatic tissue. Tissue hiperpplasia of the laser is only 0. The physical properties of this laser allow its use in different tissues and stones. HoLEP has the largest number of randomized clinical trials compared with TURP and open prostatectomy than any other available laser technology.
Based on a recent meta-analysis, the functional results are similar, and the catheter time and hospital stay were shorter in patients with HoLEP. Compared with TURP, similar functional results were observed after an average of 7. The need for morcellation of the prostatic tissue within the bladder at the end of the procedure and the long learning curve are the two main disadvantages of the method.
According to a recent analysis, the rate of enucleation efficiency was significantly different between cohorts, and the threshold was generally observed after cases conducted. Likewise, a significant difference is shown for efficiency of morcellation with stabilization in performance after 60 cases. Surgical time, hospital stay and catheter removal time were comparable between groups.
There was a significant and comparable improvement in the score of symptoms and post-void residual test at 1, 4 and 12 months. After brnigna months, the reduction of prostate size was significantly higher in the HoLEP group Faced with such facts, HoLEP has stood out as the technique used the most in North America and Europe and already appears in the guidelines of these societies as the first-line treatment.
In these cases, the first-line surgical treatments recommended hiperlasia the current guidelines of the EAU are: Despite the emergence of new technologies, the standard treatment for large adenomas is still open simple prostatectomy SPdue to the limited availability of these technologies in care centers and the advantage that open access offers when additional joint treatment is needed, such as cystolithotomy and bladder diverticulectomy. Over the years, new endoscopic and video-assisted techniques have emerged to reduce morbidity in the standard open technique.
Video-assisted surgery involving the prostate was initiated bnigna with Schuessler et al. Comparing SP with LRP, a retrospective study did not demonstrate a significant difference in the incidence and severity of complications, with similar functional results. There was no difference regarding functional results; however, surgical time in the open procedure was prlstat. Simple open prostatectomy vs. The largest retrospective multicenter study evaluating minimally invasive techniques with RASP and LRP, totaling 1, patients in 23 American and European institutions, concluded that the functional results are similar, regardless of the technique used, with similar IPSS, Hiperplasiia and sexual function Trifecta in a hiperplasa follow-up.
Current scientific evidence tends to qualify the feasible minimally invasive techniques as a safe and effective therapy for prostates with a volume above 80 mL, with a level of evidence of 2A.
As such, we can consider these different approaches as alternatives for treatment of benignw prostates, with apparent similarity of efficacy and functional results. The new minimally invasive beninga are attractive hieprplasia aimed at reducing morbidity, time of intravesical catheter use and hospitalization period, with reduction in the final cost of treatment, although still lacking scientific evidence to prove these benefits.
For more than 30 years, embolization of hypogastric arteries has been proposed to control severe prostatic hemorrhage with satisfactory results. However, according to the Bladder Obstruction Index, despite the statistically significant improvement in IPSS, QoL, Qmax and detrusor pressure, only one third of the patients were unobstructed postoperatively.
This study analyzed patients monitored for 24 months. Clinical failure rates were 3. Compared to the preoperative values, hiperplssia treatments presented improvements at all times.
The PAE group had a greater number of adverse events and complications, mainly related to acute urinary retention Prostwt total of patients from seven eligible studies were included.
The mean differences in IPSS at 3, 6, 12 and 24 months were, andrespectively. Certain complications have been reported to be associated with PAE. Among the cases described in another study, 9.
Urinary tract infection occurred in 7. Six patients had transient acute urinary retention after PAE. According to the authors, among patients with IIEF follow-up data, the score improved in There were pgostat cases of sexual impotence or retrograde ejaculation. The search for new therapeutic modalities for any disorder is necessary and natural, even more so in times of rapid technological evolution.
This is no different in the treatment of Uiperplasia, and new options are already beginning to be established in clinical practice in accordance with the consolidation and scientific support for such. We currently have two innovative techniques that present promising experimental results and in early clinical trials.
Prostate ablation using hydrodissection uses a high-speed, robot-assisted, image-guided saline jet, requiring no electrical current or high temperature and the procedure, with greater accuracy in the target tissue, minimize bleeding and indirect effect in relevant adjacent structures such as the prostatic capsule, bladder neck and external sphincter, as well as potential preservation of ejaculatory function.
The procedure is performed via cystoscopy and a needle is inserted into each prostate lobe at a time for as many times as are necessary to cover the extent of the prostate mass.
Hiperplasia prostática benigna
The preliminary results of a single RCT comparing cystoscopy with a control and one year hiperolasia follow-up in men with BPH demonstrated significant reduction of IPSS and Qmax in the treated group, with no relevant adverse effects, except for one case of urinary retention resolved in the short term.
It can be performed on an outpatient basis, presents a slightly inferior efficacy to the M- or B-TURP and HoLEP techniques, but with a much lower incidence of adverse effects, as well as significantly lower cost, thus constituting a considerable alternative for the surgical treatment of BPH.
The prevalence of prostatism: Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care: Current medical therapies for men with lower urinary tract symptoms and benign prostatic hyperplasia: EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Systematic review and economic modelling of effectiveness and cost utility of surgical treatments for men with bdnigna prostatic enlargement.
Alternative approaches to benignq ablation for benign enlargement of the prostate: Minimally invasive treatments for benign prostatic enlargement: Complications of transurethral resection of the prostate TURP: Results from an international multicentre double-blind randomized controlled trial on the perioperative efficacy and safety of bipolar vs monopolar transurethral resection of the prostate.
Bipolar transurethral resection of the prostate: Prospective randomized study comparing monopolar with bipolar transurethral resection of prostate in benign prostatic obstruction: Bipolar prostwt resection versus monopolar transurethral resection for benign prostatic hypertrophy: Treatment of non-neurogenic male LUTS: Greenlight photoselective watt nm lithium triborate laser vaporization prostatectomy in living canines.
A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: A systematic review and meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic obstruction: Long-term results of a randomized trial comparing holmium laser hipfrplasia of the prostate and transurethral resection of the prostate: Evaluation of the hipeplasia curve for holmium laser enucleation of the prostate using multiple outcome measures.
GreenLight tm hoperplasia XPS photoselective vapo-enucleation versus holmium laser enucleation of the prostate for the treatment of symptomatic benign hkperplasia hyperplasia: Holmium laser enucleation of the porstat versus open prostatectomy for prostates greater than grams: Long-term results of open transvesical prostatectomy from a contemporary series of patients.
Endoscopic enucleation versus open prostatectomy for treating large benign prostatic hyperplasia: A prospective study of the safety and efficacy of suprapubic transvesical prostatectomy in patients with benign prostatic hyperplasia. Open prostatectomy for benign prostatic enlargement in southern Europe in the late s: Transvesical open prostatectomy for benign prostatic hyperplasia in the era of minimally invasive surgery: