[Benign prostatic hyperplasia : New and treatment-relevant aspects from the DGU guidelines]. / Benignes Prostatasyndrom : Neues und Praxisrelevantes aus den DGU-Leitlinien.

The diagnosis and treatment of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement plays an important role in daily urological practice. Therefore, a targeted and resource-saving approach is essential. A rational base-line work-up of our patients provides the necessary information for obtaining the diagnosis and only needs to be expanded in individual cases. In addition to drug therapy, the modification of lifestyle and the possibility of watchful waiting must not be underestimated. Simple measures such as a timed fluid intake, double micturition in the case of residual urine development, but also bladder reconditioning can significantly improve the quality of life of our patients. Regarding surgical treatment, laser procedures have found their way into many departments and have established themselves in daily routine as a reference procedure in addition to transurethral resection of the prostate (TUR-P) and simple open prostatectomy. New, minimally invasive procedures-such as prostatic artery embolization (PAE), the Rezum™- (NxThera Inc., Maple-Grove, MN, USA) or the Aquabeam® (Procept, Redwood City, CA, USA) procedure, but also nonablative procedures such as iTind© (TIND, Medi-Tate, Or Akiva, Israel) or Urolift® (Neotract Inc., Pleasanton, CA, USA)-offer new treatment options to those affected, with the potential to maintain patient's sexual function. As a result, individual risk assessment and advice on the advantages and disadvantages of all available treatment options-even more than today-will be an important part of LUTS treatment. An individual approach, similar to that used in the treatment of oncological disease, will become standard also in the treatment of benign prostatic syndrome.

Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort.

PURPOSE: Aquablation of the prostate using the AquaBeam™ system promises equivalent functional outcomes, reduced learning curve, and improved sexual function compared to transurethral prostate resection as shown in prospective randomized trials. This prospective cohort study aims to evaluate if published results can be transferred into the clinical routine in a non-selected patient collective. METHODS: This study includes all patients treated between September 2017 and June 2018 with Aquablation of the prostate. Patients have been evaluated prospectively for the perioperative course and early follow-up. Besides voiding parameter and symptom score, TRUS-volume change, ejaculatory function, and adverse events have been recorded. RESULTS: 118 consecutive patients have been treated in the given time. Aquablation could be carried out successfully in all patients. IPSS, QoL, Qmax, and PVR improved significantly after the procedure and continued to improve during 3-month follow-up. Mean OR time was 20 min, TRUS volume decreased by 65%, and 73% of the patients retained antegrade ejaculation. Thirteen adverse events (> Clavien-Dindo I) occurred in 10 patients. CONCLUSION: The surgical ablation of the prostate using Aquablation achieved significant and immediate improvement of functional voiding parameters Qmax and PVR as well as symptomatic improvement of IPSS and QoL. Aquablation seems to be safe and effective with a low perioperative complication profile even in a non-selected group of patients.

[S2e guideline of the German urologists: Conservative and pharmacologic treatment of benign prostatic hyperplasia]. / S2e-Leitlinie der Deutschen Urologen : Konservative und medikamentöse Therapie des benignen Prostatasyndroms.

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the conservative and pharmacological treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding watchful waiting, behavioral therapy, phytotherapy and pharmacological mono- and combination therapy. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

[S2e guideline of the German urologists: Instrumental treatment of benign prostatic hyperplasia]. / S2e-Leitlinie der Deutschen Urologen : Instrumentelle Therapie des benignen Prostatasyndroms.

This report summarizes the relevant aspects of the S2e guideline of the German Urologists for the instrumental treatment of the lower urinary tract symptoms due to benign prostatic hyperplasia. Recommendations are given regarding open and transurethral procedures (TUR-P, bipolar TUR-P, TUI-P, HE-TUMT, TUNA, and the different Laser techniques). Recommendations are also given concerning intraprostatic stents and injection therapies. The influence of the different therapeutic options on bladder outlet obstruction (BOO) is described in detail.

[Transurethral resection of the prostate and current modifications (bipolar, electrovaporization)]. / Transurethrale Resektion der Prostata und Modifikationen (bipolar, Elektrovaporisation).

Transurethral resection of the prostate (TURP) is the surgical standard which is truly minimally invasive by using a natural orifice and is also of durable efficacy. The use of TURP removes tissue from benign prostatic hyperplasia (BPH) and leads to clinically relevant improvement in symptoms and quality of life as well as in micturition parameters and obstruction. Tissue is removed by high frequency (HF) current with synchronous hemostasis. Many modifications of TURP, such as the use of video, have become generally accepted and improved the standard. Other modifications were developed because the balance between cutting and hemostasis needed improvement in favor of hemostasis. Several modifications of TURP, such as modulation of HF pulses, band loops and bipolar resection and new procedures, such as vaporization and enucleation showed improved hemostasis. These modifications and procedures, however, have not yet replaced standard TURP but have become established as additional options.

Evaluation of the learning curve for Thulium VapoEnucleation of the prostate (ThuVEP) using a mentor-based approach.

INTRODUCTION: To evaluate the learning curve of Thulium:YAG VapoEnucleation of the prostate (ThuVEP) for patients with symptomatic benign prostatic obstruction (BPO) prospectively. METHODS: ThuVEP was performed using the 120 Watt 2 µm continuous wave Thulium:YAG laser. ThuVEP was done by a resident without experience in transurethral prostate surgery (A, n = 32), an experienced endourologist (B, n = 32), and an experienced surgeon in ThuVEP (C, n = 32), who served as the mentor for A/B. Patients were divided into consecutive subgroups of 8 patients to assess the impact of the learning curve on procedure outcome. Patient demographic, perioperative, and 12-month follow-up data were analysed. RESULTS: ThuVEP was successfully completed in all patients. Enucleation efficiency (g/min) differed significantly between surgeon A (0.48 ± 0.3), B (0.7 ± 0.36), and C (1.4 ± 0.67) (p ≤ 0.001). Enucleation efficiency correlated significantly with the weight of resected tissue in surgeon A (r = 0.88), B (r = 0.73), and C (r = 0.79) (p < 0.001). ThuVEP was performed by surgeon A and B with reasonable enucleation, morcellation, and overall operation efficiency after 8-16 procedures. At 12-month follow-up, 68 (71 %) patients were available for review. IPSS, QoL, Qmax, PVR, PSA, and prostate volume improved significantly at follow-up (p ≤ 0.023). Mean PSA/prostate volume reduction was 81.95/74.5, 80.7/79.4, and 87.6/75.9 % in surgeon A, B, and C, respectively. Urethral stricture and bladder neck contracture developed 2 (A = 1, B = 1; 2.1 %) patients and 1 (C, 1 %) patient each, respectively. CONCLUSIONS: ThuVEP can be performed with reasonable efficiency even during the initial learning course of the surgeon when closely mentored. Previous experience in the field of endourology is beneficial.

Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction.

BACKGROUND: Transurethral removal of prostatic tissue is the treatment choice for benign prostatic enlargement and benign prostatic obstruction. Urodynamic results are directly linked to the amount of removed tissue which, however, is directly associated with intra- and postoperative morbidity. Transurethral laser operations of the prostate offer the advantage of decreased bleeding complications and the possibility to treat patients with bleeding disorders or anticoagulative treatment. The aim of the article is to present a novel technique of complete transurethral removal of the transition zone (enucleation) with the support of the Thulium laser to combine complete anatomical enucleation and maximum urodynamic efficacy with minimal side-effects. MATERIALS AND METHODS: We present five distinct surgical steps for transurethral complete removal of the transition zone of the prostate (Thulium laser enucleation of the prostate, ThuLEP). Surgical steps are presented in chronological order with the help of intraoperative pictures. Laser energy of 70-90 W is only used for the incision at the verumontanum and bladder neck for removal of the middle lobe, whereas laser energy of 30 W was only used for coagulation of small vessel crossing the surgical capsule towards the transition zone and bladder neck for dissection of the lateral lobes. The lobes themselves are liberated by blunt dissection. CONCLUSIONS: ThuLEP offers complete removal of the transition zone no matter what prostatic size. The techniques combine maximum efficacy with minimal side-effects. Clinical results comparing ThuLEP with open prostatectomy or transurethral resection are awaited.

Laser treatments of the prostate vs TURP/ open prostatectomy: systematic review of urodynamic data.

UNLABELLED: Bladder outlet obstruction (BOO) is believed to be the major component of benign prostatic hyperplasia (BPH) that harms the urinary tract. Therefore, BOO relief is the primary treatment objective in patients with obstructive BPH. This systematic review aims to analyze urodynamic data of laser treatment modalities of the prostate in direct comparison with standard treatment (TURP or open prostatectomy). We systematically searched the literature for randomized-controlled trials (RCTs) of prostate laser treatments in which urodynamic results were compared to TURP or open prostatectomy. The literature search included articles that were published between January 1995 and January 2009. Thirty five RCTs were identified encompassing in total 3669 patients. Of all available laser treatments, only one RCT used pressure-flow data to compare the laser treatment of the prostate (holmium laser enucleation, HoLEP) with standard treatment. Improvement of maximum urinary flow rate (Q(max)) of free uroflowmetry was similar for contact laser ablation (CLAP) with Nd:YAG, interstitial laser coagulation with Nd:YAG, potassium potassium-titanyl-phosphate (KTP)/Nd: YAG hybrid treatment, and HoLEP. Qmax improvement was also similar for holmium laser ablation (HoLAP) with 60-80 Watts, holmium laser resection, and thulium laser resection but limited to only one study each. The laser hybrid therapy with CLAP/visual laser ablation of the prostate (VLAP)/Nd:YAG was inferior to TURP. VLAP and KTP showed inhomogeneous RESULTS: Most contemporary laser treatments modalities provide similar Qmax improvement compared to standard treatment. However, precise differences can only be determined by comparative computer urodynamic investigations. Therefore, new laser techniques (such as thulium laser vapoenucleation of the prostate) should be investigated by urodynamic studies in the future.

[Thulium:YAG vaporesection of the prostate. First results]. / Thulium:YAG-Vaporesektion der Prostata. Erste Erfahrungen und Ergebnisse.

OBJECTIVES: Laser treatment of benign prostatic hyperplasia has been introduced. The thulium:YAG (Tm:YAG) laser combines the advantages of established laser systems. This study reports the preliminary results of vaporesection of the prostate, using this 2-microm continuous wave (cw) laser. MATERIAL AND METHODS: A total of 54 consecutive patients were treated with the Tm:YAG laser. The outcomes measured were resection time, catheter time, improvement in urinary flow rate (Q(max)), and post-voiding residual urine (PVR). International Prostate Symptom Score (IPSS) and Quality of Life Index (QoL) were recorded. RESULTS: The mean age was 61 years. Mean prostate volume was 30.3 cc. Average resection time was 52 min. Catheter time was 1.7 days. Qmax significantly improved from 4.2 to 20.9 ml on average. PVR decreased from 86 to 16 ml. IPSS and QoL score improved from 19.8 to 6.5 and 4 to 1, respectively. No patient required re-hospitalization. Transfusions were not necessary. CONCLUSIONS: These preliminary results indicate that Tm:YAG vaporesection of the prostate is safe and efficient. The 18-month follow-up data showed major improvement in voiding symptoms and QoL. Longer follow-up is needed to prove durability of these promising results.

[Laser-based resecting techniques in the treatment of benign prostatic obstruction]. / Lasergestützte Resektionstechniken bei benigner Prostatahyperplasie.

A brought variety of options are at hand in the treatment of benign prostatic obstruction. During the last decades multiple therapeutic approaches have been pushed on the market to compete with the known Gold-Standard, the monopolar TUR-P. Only few have stood the test of time. The first wave of laser-based prostate surgery took place, when the Nd:YAG laser was introduced into clinical urology. However, operating time was long, surgical outcome often poor and the risk of serious complications was high. This lead to the vanishing of Nd:YAG lasers in clinical routine. During the last years, with growing experience in laser physics and the development of new laser types, the laser-based prostatic surgery gained importance. In clinical routine different vaporizing or resecting techniques are established and compete on the market. Aim of this article is to review those lasers, which are currently used in resection techniques and to highlight advantages, but also disadvantages of the different systems.

[Diclofenac during prostate needle biopsy. Significant pain reduction]. / Prostatastanzbiopsie unter Diclofenac. Signifikante Schmerzreduktion und Verbesserung der Patientenakzeptanz.

BACKGROUND: The aim of this study was to evaluate the efficacy of diclofenac to reduce pain during prostate biopsy. METHODS: After prospective randomization all patients received an intrarectal lidocaine gel instillation. Group 1 (n=80) functioned as control group, group 2 (n=72) received a placebo, and group 3 (n=76) a 50 mg diclofenac suppository in addition. Patients were asked to identify their pain score (VAS 10) after the biopsy. Two weeks later, the patients were called and asked about the post-biopsy course. RESULTS: Patients in the diclofenac group had significantly lower pain scores than control or placebo group patients. Another biopsy without additional anesthesia was refused by 25% of the control group and 34% of the placebo group, but only by 11% of the diclofenac group (p<0.05). CONCLUSIONS: The preinterventional administration of diclofenac suppositories is a simple but efficient procedure for pain reduction in patients who undergo prostate biopsy.

Electrogoniometric feedback: its effect on genu recurvatum in stroke.

The purpose of this study was to determine the effect of combining electrogoniometric feedback with contemporary physical therapy procedures for treatment of genu recurvatum following stroke. Twenty-six patients suffering knee hyperextension resulting from cerebrovascular disorders were allocated to either a control group or an experimental group. Both groups received treatment for knee hyperextension during two consecutive phases. During phase I the control group received physical therapy and the experimental group received electrogoniometric feedback as an adjunct to physical therapy. In phase II both groups received physical therapy alone. Each phase lasted four weeks, during which time patients were treated 45 minutes daily, five days every week. Subjects in the experimental group showed greater reduction in knee hyperextension. This was particularly evident in phase II when the difference between groups for reduction in knee hyperextension reached statistical significance (U = 40, p = 0.011). These results suggest that the addition of electrogoniometric feedback to standard physical therapy enhanced the effectiveness of treatment for genu recurvatum in stroke.

Pharmacology of the dual inhibitor of cyclooxygenase and 5-lipoxygenase 3-hydroxy-5-trifluoromethyl-N-(2-(2-thienyl)-2-phenyl-ethenyl)-benzo (b)thiophene-2-carboxamide.

3-Hydroxy-5-trifluoromethyl-N-(2-(2-thienyl)-2-phenyl-ethenyl)- benzo (b) thiophene-2-carboxamide (L-652,343) is an inhibitor of cyclooxygenase and 5-lipoxygenase in vitro and inhibits the synthesis of the products of both these pathways in whole cells. L-652,343 is an inhibitor of the acute edema induced by carrageenan in vivo and is active topically in suppressing arachidonic acid induced inflammation in the skin. The compound is an effective inhibitor of the chronic inflammation of adjuvant and type II collagen induced polyarthritis. L-652,343 is an extremely potent analgesic in models of yeast and platelet activating factor induced hyperalgesia in rats and phenylbenzoquinone-induced writhing in mice. The fever induced by Brewer's yeast is lowered by L-652,343. The ulcerogenicity and gastric bleeding induced by L-652,343 is extremely low, providing a favorable therapeutic index which is superior to that of indomethacin, piroxicam and phenylbutazone.