Contemporary surgical treatment of benign prostatic hyperplasia

Abstract

Benign prostatic hyperplasia (BPH) is a common condition in adult men and its incidence increases progressively with aging. It has an important impact on the individual's physical and mental health and its natural progression can lead to serious pathological situations. 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 several options available 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. On the other hand, new techniques and technologies arise sequentially in order to minimize aggression, surgical time, recovery and complications, optimizing results related to the efficacy/safety dyad. 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 last decade, but it still needs 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.

Analysis of Present Status for Surgery of Benign Prostatic Hyperplasia in Korea Using Nationwide Healthcare System Data

“…It is not yet popular because health insurance has not yet been applied. Although Urolift is currently performed in limited outpatients with high comorbidities due to lack of long-term outcome, it can be applied to more patients since it is an easy and safe procedure with high accessibility and lower incidence of adverse effects [22,23]. It is expected that a significant contribution will be made to one of the alternatives for surgical treatment of BPH.…”

A global knowledge, attitudes and practices survey on anatomical endoscopic enucleation of prostate for benign prostatic hyperplasia among urologists

“…Benign prostatic hyperplasia (BPH) is a bothersome condition that has high prevalence in elderly men (Lee, Chan, & Lai, 2017). Majority of practicing urologists treat BPH (Census Results—American Urological Association, n.d.) by medical therapy as well as surgical options (Herr, 2006; Nunes, Antunes, & Constantin, 2017). Removal of obstructive part of the enlarged gland in the transition zone remains the basis of surgical management (Foo, 2017; McNeal, 1988).…”

Multicenter experience with photoselective vaporization of the prostate on men taking novel oral anticoagulants

“…Transurethral resection of the prostate (TURP) is the surgical gold-standard for men with BPH [1] , [2] , however it requires prior cessation of anticoagulant therapy. Several alternative procedures are available including holmium laser enucleation of the prostate, prostatic artery embolization and photoselective vaporisation of the prostate (PVP, also known as Greenlight™ laser prostatectomy) [2] , [7] , [8] . Previous studies into PVP have assessed its efficacy and safety with concurrent administration of warfarin and/or antiplatelet medications with reassuring results [5] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] .…”