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.
One of the key concepts of modern medicine is the quality of life associated with health, which is influenced by the initial underlying disease, its timely diagnosis and quality treatment, as well as rehabilitation, further prevention and identification of complications that have arisen. The conditions and lifestyle of the patient play an important role, not only his physical health, but also mental health. Despite the fact that benign prostatic hyperplasia (BPH) is not a life-threatening disease, its main clinical signs are symptoms of dysfunction of the lower urinary tract, which to a greater extent cause discomfort to patients and significantly reduce their quality of life. One of the triggering factors for the development of prostate cancer is neglected cases of BPH progression. The occurrence of prostate cancer, as a consequence of BPH, undoubtedly worsens the patient's quality of life and requires timely diagnosis, detection and immediate treatment. Based on the literature data, the article analyzes the risk factors for the occurrence and the main methods of treatment for BPH and prostate cancer, which negatively affect the patient's quality of life.
Аннотация. В настоящее время число заболеваний предстательной железы растет: клинические признаки ДГПЖ обнаруживаются у мужчин старше 40 лет в 14% случаев, и достигают 90% к 80 годам. К основным проявлениям аденомы предстательной железы относятся такие нарушения мочеиспускания (ноктурия, ослабление струи мочи, чувство неполного опорожнения мочевого пузыря и др.), которые снижают качество жизни мужчин. В настоящее время хирургический метод лечения ДГПЖ занимает отдельную нишу. Данный способ позволяет снизить частоту интра-и постоперационных осложнений, уменьшить время реабилитации пациента и количество койко-дней, проведенных в стационаре. Совершенствование хирургических методик позволяет использовать индивидуальный подход к пациентам, уменьшить частоту осложнений, а также улучшить отдаленные результаты лечения. В статье рассмотрены техники оперативных вмешательств, которые используются для хирургического лечения пациентов с ДГПЖ, а также представлен ретроспективный обзор их совершенствования.
The article is a review of domestic and foreign literature sources covering the development of complications and long-term prognoses during radical cystectomy, as well as the history of the development of the method. The gold standard for the treatment of muscle invasive bladder cancer (MIBC) is radical cystectomy with bilateral pelvic lymph node dissection. The high incidence of intra- and postoperative complications, as well as a large number of repeat visits (up to 25 %) in the first 30 days after open radical cystectomy necessitates a search and implementation of new methods of surgical treatment, one of which is robotic-assisted radical cystectomy (RARC). The robotic method reduces the need for intra- and postoperative blood transfusion, but does not significantly improve the patient’s quality of life compared to open surgery. The main disadvantage of the RARС is the long operation time. Urinary drainage is a necessary component of radical cystectomy. The most modern methods of derivation are «dry» stoma placement and orthotopic bladder surgery with urination along the native urethra. However, the choice of urinary drainage must be made based on a number of factors, including the patient’s comorbidities, surgical feasibility, postoperative care capacity, and patient preference.
The article presented an overview of literary sources, which include a description of various surgical techniques for the treatment of benign prostatic hyperplasia in different historical periods. The assessment of the disadvantages and advantages of various surgical methods for the treatment of benign prostatic hyperplasia has been made. Modification and improvement of surgical interventions, changes in methods and approaches to surgical treatment of benign prostatic hyperplasia made the surgeon’s work more accessible and of high quality. The development of surgical methods of treatment has made it possible to increase the efficiency of surgical interventions, which, in turn, has a positive effect on the quality of life of urological patients.
Diseases of the urological profile are one of the most important medical and social issues of the modern world. According to various sources, from 50 % to 75 % of men over 50 years old have benign prostatic hyperplasia (BPH), and by the age of 80, BPH is detected in 90 % of the male population. BPH manifests itself with lower urinary tract symptoms (LUTS) in most patients. Prostate cancer ranks 2nd or 3rd in the structure of malignant neoplasms in men, and the prevalence of this pathology continues to grow. This trend is associated with an increase in average life expectancy, improved diagnosis of pathologies and early detection of the disease. Risk factors affecting the development of both prostate cancer and BPH include the patient’s age, race, family history, eating habits, the presence or absence of bad habits, and a sedentary lifestyle. Surgical methods for treating prostate cancer include open retropubic prostatectomy and laparoscopic adenomectomy. The «gold standard» of surgical treatment of BPH is transurethral resection of the prostate (TURP), but the emergence of new endovideosurgical methods (bipolar TURP, transurethral enucleation of the prostate (TUEP) allows to expand the scope of their use and reduce possible complications in the early and late postoperative period.
The use of laser technology in the surgical treatment of patients with benign prostatic hyperplasia has recently become widespread and introduced into practice. This area of surgery uses a large range of laser modifications and methods of their application when performing surgical interventions on the prostate. The article discusses laser devices for minimally invasive operations on patients with benign prostatic hyperplasia in comparison with traditional methods of BPH surgical treatment. The advantages of using laser technologies include the reduction of the time of surgical intervention, the decrease in the number of traumatic complications and bleeding, the absence of the damaging effect of the shock wave, the possibility of using it with surgical instruments of the minimum diameter, and the possibility of using it with flexible surgical instruments.
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