EAU Guidelines on Benign Prostatic Hyperplasia (BPH)

Rosette, Jean J.M.C.H. de la; Alivizatos, Gerasimos; Madersbacher, Stephan; Perachino, M.; Thomas, David R.; Desgrandchamps, François; Wildt, Michel de

doi:10.1159/000049784

Cited by 267 publications

(234 citation statements)

References 38 publications

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“…Nevertheless, PFS is currently the gold standard technique for the differentiation of BOO and detrusor hypocontractility. Except for this indication, PFS is an optional test for the routine evaluation of elderly men with LUTS (13,14) as it is expensive and invasive. Klinger et al (15) observed severe complications, such as urinary retention and gross hematuria during or after urodynamic investigations, in up to 19% of patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic values of detrusor wall thickness, postvoid residual urine and prostate volume to evaluate lower urinary tract symptoms in men

Tokgöz

Tokgöz²,

Ünal³

et al. 2011

Diagn Interv Radiol

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Lower urinary tract symptoms (LUTS) are common, affecting approximately 40% of older men (1). LUTS is a recent term for what used to be known as prostatism (2). However, obstructive disorders of the lower urinary tract may also be caused by other diseases, such as bladder neck contractures, urethral valves, or external sphincter dyssynergia. However, for the majority of cases in the male population, the etiology is benign prostatic hyperplasia (BPH).Various animal and human studies have revealed that a significant enlargement of the bladder wall is attributable to smooth muscle cell hypertrophy, fibrocyte hyperplasia, and collagen deposition in the detrusor (3, 4). From a clinical perspective, thickening of the bladder wall should be considered as a sign of significant subvesical obstruction (5). The best way to visualize this detrusor muscle hypertrophy in a noninvasive manner is to measure the detrusor wall thickness (DWT) by suprapubic ultrasonography. In 2006, Belal and Abrams (6) evaluated noninvasive methods used to diagnose bladder outlet obstruction (BOO) in a meta-analysis and observed that ultrasound measurements of the DWT and bladder weight were the only predictors of subvesical obstruction in LUTS patients.It is widely accepted that DWT decreases continuously while the bladder fills to 50% of its capacity and then remains constant until 100%. Therefore, the detrusor wall measurements are performed on patients when the bladder is filled to maximum capacity only (7). However, no study has been published that evaluates the diagnostic accuracy of DWT when the bladder is empty. In our study, we investigated the association between the LUTS severity and DWT. In addition, the parameter "DWT when the bladder was empty" was also evaluated as a noninvasive diagnostic tool to predict LUTS in men.An ideal assessment tool to detect LUTS must be noninvasive, quick, inexpensive, and reproducible with high diagnostic accuracy. Ultrasonography has all of these criteria with additional advantages (no contrast material and no ionizing radiation). In uro-radiology practice, conventional ultrasound-derived noninvasive tests for the evaluation of LUTS severity can achieve measurements of DWT, postvoid residual urine volume (PVR), and prostate and bladder volumes. Hence, our primary aim in this prospective, controlled clinical study was to analyze the diagnostic accuracy of these ultrasound-derived noninvasive tools (i.e., DWT when the bladder is full and empty, PVR, and bladder and prostate volumes) in healthy, mildly symptomatic, and moderately-toseverely symptomatic men, and compare the outcomes in each group. In addition, their correlation according to International Prostate Symptom Score (IPSS) and age groups as well as differences in DWT values were also investigated. Our hypothesis was that these tests would accurately discriminate symptomatic cases from healthy subjects and would ABDOMINAL IMAGING MATERIALS AND METHODSDuring an 18-month period, a total of 243 males were included in the study. Three groups were a...

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Section: Discussionmentioning

confidence: 99%

Diagnostic values of detrusor wall thickness, postvoid residual urine and prostate volume to evaluate lower urinary tract symptoms in men

Tokgöz

Tokgöz²,

Ünal³

et al. 2011

Diagn Interv Radiol

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“…Bleeding necessitating transfusion (2-5%), TUR syndrome (2%), bladder-neck contracture (4%), urethral stricture (3.8%), incontinence (2.2%), erectile dysfunction (6.5%), retrograde ejaculation (65-70%), irritating voiding symptoms and urinary tract infections are complications of TURP. [2,3] These complications occur in varying proportions depending on the patient's age, the presence of co-morbid diseases, and the surgeon's experience. New technologies have been developed to prevent these complications.…”

Section: Introductionmentioning

confidence: 99%

Comparative outcomes of plasmakinetic versus monopolar transurethral resection of benign prostatic hyperplasia: 7 years' results

Erturhan

Bayrak

Şeçkiner

et al. 2013

Turkish Journal of Urology

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Objective: We compared results from the standard monopolar or the bipolar plasmakinetic method for the transurethral resection of the prostate (TURP) due to benign prostatic hyperplasia (BPH) at 4 and 7 years after surgery (medium to long term). Material and methods:A retrospective analysis was performed on the complete data from 124 patients who were alive and had 7 years of regular follow-up. Of those 124 patients with BPH, 65 (52%) underwent monopolar TURP (M-TURP) and 59 (48%) underwent plasmakinetic TURP (P-TURP). During the followup period, the International Prostate Symptom Score (IPSS), the maximal flow rate (Qmax) measured using uroflowmetry and the prostate specific antigen (PSA) values were recorded. Patients in whom alpha blockers were administered due to the growth of postoperative adenoma and who had been operated on due to urethral stricture, bladder neck contracture or a growing adenoma were also noted and recorded.Results: There was no statistically significant difference between M-TURP and P-TURP groups in any pre-operative or post-operative follow-up parameter at 4 or 7 years post-surgery. Specifically, PSA, IPSS and Qmax values; urethrotomies performed; alpha-blocker use; and the frequency of re-operations were statistically insignificant (p>0.05). Conclusion:Our study demonstrated that when medium-to long-term results are compared, P-TURP and M-TURP appear to result in similar IPSS scores, Qmax values, complication rates and retreatment rates. Larger prospective studies are required to corroborate these results.

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“…In this study urethral catheter was removed between 2-5 days in all 30 cases (100%) of TURP, but in Freyer's prostatectomy it was kept up to average 10 days (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18).…”

Section: Gohel Jb Et Al Int Surg J 2017 Jan;4(1):257-263mentioning

confidence: 90%

“…Currently, TURP is considered as the reference or standard treatment for the prostate less than 70 to 80 g. [3][4][5] Open prostatectomy (OP) is still being performed for operations of the prostates in which TURP is preferable in many developing and even developed countries. Percent of OP in the late 1990 and early 2000 in Sweden, France, Italy, and the Mediterranean coasts ranged from 14% to 40%.…”

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Comparative evaluation of different modalities of treatment in benign prostatic hyperplasia at tertiary care teaching institute

Gohel

Patel

2016

Int Surg J

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Background:Benign prostatic hyperplasia (BPH) is the most common disease occurring in men as the age advances. There are various treatment modalities available, amongst which trans-urethral resection of prostate (TURP) is widely used but role of open Freyer's prostatectomy and medical management can't be ignored at the same time. This study was done to compare different modalities of treatment, to evaluate the individual modality in view of its efficacy, complications and patient satisfaction, to compare the different modalities in their efficacy for management of BPH and their complication profile, to suggest the best form of therapy that can be offered to patients.Methods: A retrospective comparative study was conducted including 90 patients having benign prostatic hyperplasia (BPH) were enrolled for the study and randomly divided into three groups of 30 patients each. Group I consists of patients undergoing for Freyer's prostatectomy, Group II consists of patients undergoing TURP and in Group III patients were managed conservatively with medical management. Results:Temporary Incontinence of urine was the most common complication occurred found in 6 cases (20%) in Freyer’s prostatectomy group I and in 3 cases (10%) in TURP group II; per-urethral catheter was removed between 2-5 days in all 30 cases (100%) of TURP, but in Freyer’s prostatectomy it was kept up to average 10 days (8-18); All 30 cases (100%) of in Group II where TURP done were discharged within 6 days of surgery whereas in Group I where Freyer's prostatectomy done, most of the cases 21 (70%) were discharged between 11-15 days post-operatively. In Group III, patients were managed by medical management patients, 11 cases (36.67%) presented with acute urinary retention (AUR) and 19 (63.33%) patients presented with lower urinary tract symptoms (LUTS) without retention.Conclusions:TURP is having definite advantage over Freyer's prostatectomy, because Length of hospitalization, postoperative complications are less frequent. Transurethral resection is the method of choice in the treatment of benign prostatic hyperplasia especially in patients with mild to moderate prostatic enlargement and in the elderly patients with co-existing medical disease. Endoscopic instruments, training and more experience is required for TURP. Medical management can delay immediate surgery but later on surgical management is usually required.

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EAU Guidelines on Benign Prostatic Hyperplasia (BPH)

Cited by 267 publications

References 38 publications

Diagnostic values of detrusor wall thickness, postvoid residual urine and prostate volume to evaluate lower urinary tract symptoms in men

Diagnostic values of detrusor wall thickness, postvoid residual urine and prostate volume to evaluate lower urinary tract symptoms in men

Comparative outcomes of plasmakinetic versus monopolar transurethral resection of benign prostatic hyperplasia: 7 years' results

Comparative evaluation of different modalities of treatment in benign prostatic hyperplasia at tertiary care teaching institute

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