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1.
Zhonghua Yi Xue Za Zhi ; 101(2): 137-141, 2021 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-33455130

RESUMO

Objective: To compare the clinical effect of different total prostate volume (TPV) and different transitional zone volume (TZV) on benign prostatic hyperplasia (BPH) treated with transurethral resection of prostate(TURP). Methods: Clinical data of 210 patients with BPH admitted to Guizhou provincial people's hospital from June 2016 to August 2018 were retrospectively collected and analyzed. All patients underwent transrectal ultrasonography, and they were divided into three groups according to TPV: 70 patients in group A:TPV<40mL, 98 patients in group B: 40 ml≤TPV<80 ml, and 42 patients in group C:TPV≥80 ml. Meanwhile, three groups were divided according to TZV: 88 patients in group a: TZV<20ml, 67 patients in group b: 20 ml≤TZV<40 ml, and 55 patients in group c:TZV≥40 ml. All of the patients with TURP were followed up for 6 months after surgery, and the data of international prostate symptom score (IPSS), storage symptoms IPSS (IPSS-S), voiding symptoms IPSS (IPSS-V), Quality of Life (QoL) index, and maximum urinary flow rate (Qmax) were collected before and after surgery. Finally, the effect of TPV and TZV on TURP was analyzed respectively by analysis of variance. Results: There were no statistically significant differences in preoperative IPSS, IPSS-V, IPSS-S, QoL and Qmax among the three groups of patients grouped by TPV (P>0.05), but the age of patients in group C(73.5±6.5) was significantly higher than that in group A (69.3±7.6) and group B (70.9±7.3) (P=0.015). Postoperative IPSS, IPSS-V, IPSS-S, QoL and Qmax of patients in groups A, B and C also showed no significant difference (P>0.05). There were no statistically significant differences in preoperative IPSS, IPSS-V, IPSS-S, QoL, and Qmax among the three groups of patients grouped according to TZV (P>0.05), while the age of patients in group a (69.2±7.6) was significantly lower than that of patients in group b (72.1±7.2) and group c (72.5±6.7) (P=0.017). There were statistically significant differences in IPSS (P=0.010), IPSS-V (P=0.037), IPSS-S (P=0.022), QoL (P=0.038) and Qmax (P=0.037) among the groups a, b, and c after surgery. Moreover, IPSS, IPSS-V, IPSS-S and QoL were negatively correlated with TZV, while Qmax was positively correlated with TZV. Postoperative IPSS, IPSS-V, IPSS-S, QoL and Qmax were significantly different from those before surgery in groups A, B, C and groups a, b, c (P<0.001). Conclusion: TPV and TZV may not be significantly correlated with BPH symptoms, but may be correlated with age. TURP is an effective treatment for patients with different TPV and TZV. There is no significant statistical difference in the surgical efficacy among patients with different TPV, but patients with larger TZV tended to have better outcome. TZV may be better than TPV in predicting the postoperative efficacy.


Assuntos
Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhonghua Nan Ke Xue ; 26(3): 242-249, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33346964

RESUMO

Objective: To compare the clinical effect and safety of monoplane holmium laser enucleation of the prostate (MP-HoLEP) from those of biplane HoLEP (BP-HoLEP) in the treatment of large-volume BPH. METHODS: We retrospectively analyzed the clinical data on 67 cases of large-volume BPH treated in Jintan People's Hospital from June 2017 to December 2018, 30 by MP-HoLEP with incisions at 5- and 7-o'clock positions beside the verumontanum and the other 37 by BP-HoLEP with incision at 12 o'clock in the bladder neck to expose the surgical capsule layer. We compared the perioperative, postoperative and follow-up data between the two groups of patients. RESULTS: There were no statistically significant differences between the two groups of patients in the age, disease course, prostate volume or preoperative post-void residual urine volume (PVR), maximum urine flow rate (Qmax), IPSS, PSA level and quality of life score (QOL). Compared with the patients in the MP-HoLEP group, those treated by BP-HoLEP showed a significantly shorter operation time (ï¼»97.65 ± 34.72ï¼½ vs ï¼»125.46 ± 47.58ï¼½ min, P < 0.01) and tissue-enucleation time (ï¼»60.34 ± 23.45ï¼½ vs ï¼»97.43 ± 35.51ï¼½ min, P < 0.01) and lower intraoperative level of hemoglobin (ï¼»14.58 ± 1.11ï¼½ vs ï¼»21.44 ± 1.28ï¼½ g, P < 0.01). Statistically significant differences were not observed in the intraoperative adverse events, volume of the resected tissue, time of bladder irrigation or length of postoperative hospital stay, nor in the incidence of transient urinary incontinence (33% vs36.8%, P > 0.05). PVR, Qmax, IPSS and QOL were improved similarly in both of the groups at 6 months postoperatively. CONCLUSIONS: Both MP-HoLEP and BP-HoLEP are definitely effective for the treated of large-volume BPH, but the latter is superior to the former for shorter operation and enucleation time and less bleeding.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Hólmio , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
3.
Zhonghua Nan Ke Xue ; 26(3): 250-253, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33346965

RESUMO

Objective: To find the causes of the failure in the first catheter removal (CR) after transurethral resection of the prostate (TURP) and the related risk factors. METHODS: We collected the clinical data on 285 BPH patients treated by TURP from June 2015 to May 2018. We divided the cases into a successful CR (SCR) and a failed CR (FCR) group and investigated the risk factors for the first CR after TURP by multivariate logistic regression analysis. RESULTS: CR was successfully performed in 246 and failed in 39 of the 285 cases. In the FCR group, post-CR urinary retention occurred in 15 cases immediately after, severe urinary tract irritation in 13, massive gross hematuria in 7 and urinary incontinence in 4 within 1 month. Multivariate logistic regression analysis showed that the independent risk factors for CR failure included IPSS (OR = 5.106, P = 0.013), preoperative urinary tract infection (OR = 3.835, P = 0.041), prostate volume (OR = 4.160, P = 0.011) and catheter compression time (OR = 4.051, P = 0.017). CONCLUSIONS: The common causes of the failure in catheter removal after TURP included early postoperative urinary retention, urinary infection, secondary hematuria and urinary incontinence.


Assuntos
Cateteres , Remoção de Dispositivo/efeitos adversos , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Fatores de Risco , Ressecção Transuretral da Próstata/efeitos adversos , Resultado do Tratamento
4.
Urologiia ; (6): 38-43, 2020 Dec.
Artigo em Russo | MEDLINE | ID: mdl-33377677

RESUMO

AIM: To study the efficacy and safety of using sildenafil in patients with erectile dysfunction (ED) and concomitant cardiovascular diseases (CVD) who underwent transurethral resection of the prostate (TURP). MATERIAL AND METHODS: A total of 59 patients (age from 50 to 75 years) with a diagnosis of benign prostatic hyperplasia (BPH), requiring surgical treatment due to inefficiency of drug therapy, I-PSS score more than 20 points), who were sexually active, but had erectile dysfunction (IIEF score < 21), coronary heart disease (NYHA class I) and stage 1-2 hypertension with stable blood pressure. All patients underwent bipolar TURP. From the first day after the TURP, therapy was prescribed as following: tamsulosin 0.4 mg once a day for 90 days, ciprofloxacin 500 mg twice a day for 10 days. In addition, the patients received treatment for comorbidities. In the main group (n=30), men additionally received sildenafil (EFFEX Sildenafil Evalar) 50 mg daily for 60 days, starting from the 30th day postoperatively. We have chosen this drug from an economic standpoint. RESULTS: At baseline, all patients in both groups had hemodynamic and microcirculatory disorders in the prostate, which got worse in the early postoperative period. During the long-term follow-up, hemodynamic and microcirculatory impairments decreased. This effect was more pronounced in patients who received sildenafil. In addition, patients had an improvement in sexual function. During follow-up, there was no adverse effects of sildenafil on hemodynamic parameters (blood pressure, heart rate). CONCLUSION: Our results allow to recommend sildenafil in order to restore sexual function postoperatively in patients with BPH, including those with concomitant cardiovascular disorders.


Assuntos
Disfunção Erétil , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Disfunção Erétil/tratamento farmacológico , Disfunção Erétil/etiologia , Humanos , Masculino , Microcirculação , Hiperplasia Prostática/complicações , Hiperplasia Prostática/cirurgia , Citrato de Sildenafila/uso terapêutico , Resultado do Tratamento
5.
Urologiia ; (6): 58-63, 2020 Dec.
Artigo em Russo | MEDLINE | ID: mdl-33377680

RESUMO

AIM: To study the efficiency of using alfuzosin 10 mg (Alfuprost MR, SUN Pharma) in routine clinical practice in order to predict its feasibility for treating acute urinary retention. MATERIALS AND METHODS: A total of 47 patients, aged from 54 to 88 years old (mean 68.5+/-5.6) with acute urinary retention due to benign prostatic hyperplasia were treated at the urology department of City clinical hospital named after D.D. Pletnev from September to December 2019. 14 patients were excluded from the study since they had chronic urinary retention. In all cases, urethral catheter was put and left in place for 24-72 hours (mean 44+/-12). All 33 patients were prescribed alfuzosin 10 mg. After removal of the urethral catheter, spontaneous voiding was restored in 19 patients. Transurethral resection of the prostate was consequently performed in three patients. In one patient, the urethral catheter was changed to cystostomy tube due to the urethritis. Recurrent urinary retention occurred in 10 men, and 8 patients underwent cystostomy. In other two cases, spontaneous voiding was restored after repeated removal of the urethral catheter. RESULTS: the efficiency of conservative therapy was 63.6% (21/33). According to our results, history of severe lower urinary tract symptoms, the prostate volume more than 50 cc and intravesical protrusion of more than 1 cm have a significant influence on the outcome of conservative therapy in patients with acute urinary retention. CONCLUSIONS: Based on a prospective study, a high efficiency and safety of the Alfuprost MP 10 mg/day in patients with acute urinary retention was established.


Assuntos
Hiperplasia Prostática , Ressecção Transuretral da Próstata , Retenção Urinária , Doença Aguda , Antagonistas Adrenérgicos alfa , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Quinazolinas , Retenção Urinária/tratamento farmacológico , Retenção Urinária/etiologia
6.
Zhonghua Nan Ke Xue ; 26(1): 36-41, 2020 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-33345475

RESUMO

Objective: To investigate the effect of intraoperative lithotomy position (LP) with a head-down tilt (HDT) on the absorption of intraoperative irrigation fluid in patients undergoing bipolar plasmakinetic resection of the prostate (PKRP). METHODS: Eighty BPH patients underwent PKRP, 40 in a conventional 0-degree position (0° LP) and the other 40 in a -10-degree HDT position (-10° LP), with 0.9% saline containing 1% ethanol as intraoperative irrigation fluid. We determined the alcohol concentration in the exhaled breath of the patients with a digital alcohol detector at the start of the operation and every 10 minutes afterwards. Meanwhile we recorded the operation time, the volume of intraoperative intravenous crystalloid infusion and the weight of the resected prostatic tissue, monitored the mean arterial pressure (MAP) and heart rate (HR) at 5 minutes before surgery, 30 minutes after the start of surgery and the end of surgery, and measured the concentrations of Na+, K+, Cl- and Ca2+ with an arterial blood gas analyzer at 5 minutes before surgery and 1 hour after the start of surgery. RESULTS: There were no statistically significant differences in age, height, body weight and prostate volume, or in intraoperative MAP and HR between the 0° LP and -10° LP groups. Compared with the baseline, at 1 hour after the start of PKRP, the patients in the 0° LP group showed significantly decreased concentrations of K+ (ï¼»3.64 ± 0.29ï¼½ vs ï¼»3.49 ± 0.22ï¼½ mmol/L, P = 0.002) and Ca2+ (ï¼»1.16 ± 0.03ï¼½ vs ï¼»1.13 ± 0.04ï¼½ mmol/L, P = 0.001), increased concentration of Cl- (ï¼»106.9 ± 2.2ï¼½ vs ï¼»108.7 ± 2.3ï¼½ mmol/L, P = 0.006), but no significant difference in the concentration of Na+ (ï¼»139.7 ± 1.5ï¼½ vs ï¼»139.4 ± 1.6ï¼½ mmol/L, P = 0.231), while those in the -10° LP group exhibited remarkably decreased concentration of Ca2+ (ï¼»1.14 ± 0.04ï¼½ vs ï¼»1.13 ± 0.04ï¼½ mmol/L, P = 0.016) but no statistically significant differences in the concentrations of Na+ (ï¼»140.3 ± 1.8ï¼½ vs ï¼»140.0 ± 2.0ï¼½ mmol/L, P = 0.156), K+ (ï¼»3.49 ± 0.36ï¼½ vs ï¼»3.47 ± 0.34ï¼½ mmol/L, P = 0.506) and Cl- (ï¼»108.2 ± 2.6ï¼½ vs ï¼»109.1 ± 2.5ï¼½ mmol/L, P = 0.071). Over 1 500 ml of intraoperative irrigation fluid absorption was observed in 6 cases (15%) in the 0° LP group as compared with 4 cases (10%) in the -10°LP group, with no significant difference between the two groups. CONCLUSIONS: Lithotomy position with a 10-degree head-down tilt can reduce PKRP-induced decrease in the concentration of K+ and increase in that of Cl- without affecting the levels of the other electrolytes.


Assuntos
Decúbito Inclinado com Rebaixamento da Cabeça , Posicionamento do Paciente , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Duração da Cirurgia , Hiperplasia Prostática/cirurgia , Irrigação Terapêutica
7.
Arch Esp Urol ; 73(9): 784-793, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-33144532

RESUMO

INTRODUCTION: Open prostatectomy is an efficacious treatment for Benign Prostatic Hyperplasia (BPH), but its complication rates and risk factors for these might vary due to the characteristics of populations and health systems. OBJECTIVE: To determine the frequency of complications and the risk factors for these, in the first three months after open prostatectomy in a hospital in Medellín (Colombia). METHODS: This is a cohort study in which patients undergoing retropubic open prostatectomy were taken. Medical records were reviewed to obtain demographic, preoperative, and intraoperative data. The main outcome was the incidence of complications in the first three postoperative months and this was divided into early (day 1 to 7 post-surgery) and late (day 8 to 90 post-surgery) complications. Risk factors were determined by estimating Relative Risks (RR). RESULTS: 191 patients with a median age of 70 years were included. The frequency of complications was 34.5%,14.6% occurred early and 19.9% late. Risk factors were dyslipidemia (RR: 2.37, 95% CI: 1.25 to 4.47), irrigation time (RR: 1.31, 95% CI: 1.02 to 1.67) and duration of the postsurgical catheter (RR: 1.07, 95% CI: 1.03 to 1.12); general anesthesia was a protective risk factor compared to spinal (RR: 0.47, 95% CI: 0.24 to 0.91). CONCLUSION: The frequency of complications of open prostatectomy with a retropubic approach was within the figures reported in the literature. The risk factors found could be modifiable and considered for the prevention of adverse outcomes. This study provides an updated basis for future comparisons with alternative treatments for BPH.


Assuntos
Hiperplasia Prostática , Idoso , Estudos de Coortes , Colômbia/epidemiologia , Humanos , Hiperplasia , Masculino , Prostatectomia/efeitos adversos , Hiperplasia Prostática/cirurgia
8.
Medicine (Baltimore) ; 99(46): e22882, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181656

RESUMO

OBJECTIVE: To assess the safety and efficacy of different endoscopic procedures of the prostate techniques, by comparing endoscopic enucleation (EEP) and endoscopic vaporization procedures (EVP) of the prostate; and laser enucleation procedures (L-EEP) vs laser vaporization procedures (L-EVP) surgeries for benign prostatic hyperplasia. METHODS: A systematic literature review was performed in December 2019 using PubMed, Embase and the Cochrane Library to identify relevant studies. Two analyses were carried out: (1) EEP vs EVP; and (2) L-EEP vs L-EVP. Efficacy and safety were evaluated using perioperative data, functional outcomes, including maximum urinary flow rate (Qmax), quality of life (QoL), international prostate symptom score (IPSS), postvoiding residual urine volume (PRV), and rate of complications. Meta-analyses were conducted using RevMan5.3. RESULTS: Sixteen studies (4907 patients) evaluated EEP vs EVP, and 12 of them (4392 patients) evaluated L-EEP vs L-EVP. EEP showed improved functional outcomes compared with EVP. EEP was always presented a better Qmax at various follow-up times. EEP also associated with a reduced PRV and IPSS at 12 months postsurgery, an increased Qmax, and reduced IPSS and QoL score at both 24 and 36 months postsurgery. In addition, EEP was associated with less total energy utilized and retreatment for residual adenoma, but a longer catheterization time. Among other outcomes, there was no significant difference. L-EEP favors total energy used, retreatment for residual adenoma, and functional outcomes. L-EEP was associated with reduced PRV at 1, 6, and 12 months postsurgery, a greater Qmax at 6 and 12 months postsurgery, a lower IPSS at 12 months postsurgery, and higher Qmax and lower IPSS and QoL scores at 24 and 36 months postsurgery. However, there was no difference at 3 months postsurgery. No significant differences were observed for other perioperative data and complications. CONCLUSIONS: Both EEP and EVP displayed sufficient efficacy and safety for treating benign prostatic hyperplasia. EEP and L-EEP were favored in perioperative data, rate of complications, and functional outcomes. However, the clinical significance of those statistical differences was unclear. Hence, higher-quality randomized controlled trials may be needed to provide a clear algorithm.


Assuntos
Endoscopia/métodos , Terapia a Laser/métodos , Próstata/cirurgia , Prostatectomia/métodos , Hiperplasia Prostática/cirurgia , Idoso , Estudos de Casos e Controles , Pesquisa Comparativa da Efetividade , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto , Estudos Retrospectivos , Resultado do Tratamento , Volatilização
9.
Arch Esp Urol ; 73(8): 689-698, 2020 10.
Artigo em Espanhol | MEDLINE | ID: mdl-33025914

RESUMO

Endoscopic enucleation of the prostate was first described by Hiraoka in 1986, using a monopolar resectoscope. His contribution was largely ignored until Gilling and Fraundorfer published their three-lobe enucleation technique with the Holmium laser in 1998 ,that ended establishing itself as a reliable option for the treatment of HBP, backed by ample scientific evidence. Later on, enucleation performed with other lasers, as well as bipolar energy, have shown concordance in their clinical results. As a result, the term AEEP (anatomic endoscopic enucleation of the prostate) emerged to encompass all these techniques. During the last few years there have been significant advances in two areas: first, technology, with the development of pulse modulation for Holmium generators (MOSES) as well as high-speed morcellators. Second, the development of new surgical techniques that recognize the importance of the early release of the sphincter from the apex of the adenoma during the operation as well as the careful preservation of the external sphincter's mucosa, to avoid early stress incontinence. In this paper,we review the recent evolution of both technology and surgical technique. AEEP has been risen to a new level, reducing operative time significantly, usually under one hour, and radically reducing the incidence of early temporary stress incontinence, and maybe also facilitating the learning curve of AEEP.


Assuntos
Lasers de Estado Sólido , Hiperplasia Prostática , Endoscopia/instrumentação , Humanos , Desenvolvimento Industrial , Lasers de Estado Sólido/uso terapêutico , Masculino , Prostatectomia , Hiperplasia Prostática/cirurgia
10.
Arch Esp Urol ; 73(8): 675-681, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-33025912

RESUMO

Greenlight laser prostate vaporization is considered a valid alternative to transurethral prostate resection (TURP) for patient with LUTS due to BPH. The current review highlights the current evidence on greenlight technique and current state of-the-art. We will review clinically relevant concerns such as size limitation, economic issues and same-day surgery options. We will also describe technological improvements overtime and its relationship with current vaporization practices.CURRENT SITUATION: Based on clinical trial Goliath, Greenlight 180W vaporization showed non-inferiority to TURP and similar mid-term functional outcomes. A benefit towards length of hospital stay, similar complication rate (below 80% at 2 years). The current laser generators (higher potency) are able to provide an ablative effect on tissue that is associated to a shorter operative time. The major advantage of greenlight laser is the same day discharge, with a low readmission rates. Greenlightlaser is more cost-effective than TURP. CONCLUSIONS: Green light laser remains as an alternativevalid option despite the technological improvementsin the field.


Assuntos
Terapia a Laser , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Humanos , Masculino , Duração da Cirurgia , Hiperplasia Prostática/cirurgia
11.
Arch Esp Urol ; 73(8): 682-688, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025913

RESUMO

Thulium lasers operate at wavelengths between1940-2013 nm either in a continuous wave or in a pulsed mode, which enables smooth incisions with fast vaporization or effective laser lithotripsy for urolithiasis. Thulium laser enucleation is a minimally invasive and size-independent treatment for benign prostatic hyperplasia (BPH) with excellent long-term results. Since its introduction, several modifications in the technology and surgical techniques have been proposed such as vaporesection, vaporization and enucleation with regard to BPH treatment. Recent developments in the thulium laser technology include the introduction of a super pulsed thulium fiberlaser.  This technique delivers the laser energy through anactive fiber with an absorption maximum in water at awavelength of 1940 µm. Preclinical studies showed asignificantly higher stone fragmentation rate in differentex vivo models compared to the Ho:YAG laser. Another innovative thulium laser that works, as a hybrid laser has yet not been tested clinically, however, will soon be introduced. With the introduction of both new thulium lasers as novel devices, the armamentarium in the field of endourology for lithotripsy and enucleation increases. We here present different thulium lasers and surgical techniques that are possible to perform with each device including the reasons and advantages of each modification.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Litotripsia a Laser , Hiperplasia Prostática , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia , Túlio
12.
Arch Esp Urol ; 73(8): 699-708, 2020 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-33025915

RESUMO

OBJECTIVE: Prostate enucleation is becoming more relevant within BPH treatment. Nowadays is probably the gold standard for enucleation. Several studies have shown holmium laser as the most frequently used safe and efficient energy source. The long learning curve remains as its major drawback. The current review aims to describe step to step technique at our institutionand describing the rational for its use. METHODS: A detailed description on our  step-to-step Holep technique is provided. We focused on the main differences with other techniques already described highlighting the largest experience reported. RESULTS: None of the published series has shown better results in terms of functional, safety and less complications outcomes on the short and long term. No differences are shown in terms of intraoperative/postoperative blood loss, reoperations, capsular perforations or urethral strictures. Our techniques provides shorter surgical length and improved efficiency than blocking and trilobular techniques. The rates of early continence are 4% vs5-40%. Lastly, improvement in morcellator devices delivered no complications related to that part of the surgery. CONCLUSIONS: Holep is the gold standard technique for prostate enucleation. It provides improved functional and safety outcomes than with other techniques. A standardized and optimized technique is mandatory.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Estreitamento Uretral , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia
13.
Arch Esp Urol ; 73(8): 745-752, 2020 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33025919

RESUMO

OBJECTIVE: To assess current efficacyand safety of low power HoLEP (Holmium Laser Enucleationof the Prostate) for the treatment of obstructingand symptomatic prostatic adenomas and to identify themechanisms supporting the related clinical advantages. METHODS: A systematic review was conducted usingrelevant databases (Ovid Medline, PubMed, Scopusand Web of Sciences), employing ("low power" OR"high power") AND ("HoLEP" OR "holmium laser enucleationof the prostate") as search terms. Inherent publicationswere selected according to the Preferred ReportingItems for Systematic Reviews and Meta-analyses (PRISMA)guidelines. Additionally, the reference lists of theselected papers were checked manually. RESULTS: We included any kind of study (n=15) dealingwith low power HoLEP because of the scarcity of the resultsobtained with the bibliographic search. Low powerHoLEP seems to be fully comparable to the traditionalhigh power HoLEP in terms of feasibility, efficacy andsafety. An additional clinical advantage of the low powerapproach might be the reduced incidence of postoperativedysuria, with limited intensity and duration, possiblydue to the decreased amount of energy delivered tothe capsular plane with a less aggressive modality, conjugatedwith appropriate technical enucleative choices.The physical rationale of low power HoLEP is discussed. CONCLUSIONS: Low power HoLEP is feasible, safeand effective, and might play a not exclusive role in thereduction of incidence, intensity and duration of postoperative dysuria.


Assuntos
Terapia a Laser , Lasers de Estado Sólido , Hiperplasia Prostática , Humanos , Lasers de Estado Sólido/uso terapêutico , Masculino , Hiperplasia Prostática/cirurgia , Resultado do Tratamento
14.
Urologe A ; 59(10): 1177-1186, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32886138

RESUMO

Surgical treatment of benign prostatic obstruction (BPO) is one of the most common procedures in urology. Numerous alternative methods have been developed in recent years to overcome the potential limitations of transurethral resection of the prostate (TURP) while providing comparable effectiveness and less morbidity. In a randomized study with a currently available follow-up of 3 years, the Aquabeam® system has shown comparable functional results with a lower rate of adverse events compared to TURP. Sufficient functional results were also found in a cohort study in patients with prostate volumes up to 150 ml. However, the rate of transfusions raises the question of optimal coagulation. Further cohort studies with short-term follow-up confirmed the results of the randomized studies. Prostate artery embolization (PAE) has been compared to TURP in several randomized trials. In randomized studies, the reduction of BPO-associated symptoms after PAE is only slightly inferior to that after TURP. In contrast, the improvement of functional parameters after embolization is inferior to that after TURP. This is primarily due to the inferior desobstruction. In addition, long-term results from randomized studies are lacking, so that no final assessment has yet been possible with regard to the durability of the desobstruction. In summary, both Aquabeam® and PAE are potential alternatives to standard methods, which-in case of adequate patient selection-can supplement the operative armamentarium in the wider concept of an individualized therapy of BPO.


Assuntos
Hiperplasia Prostática , Ressecção Transuretral da Próstata , Estudos de Coortes , Humanos , Masculino , Hiperplasia Prostática/cirurgia , Resultado do Tratamento
15.
Urologe A ; 59(10): 1187-1194, 2020 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32930822

RESUMO

BACKGROUND: In an aging society an increase of benign prostatic obstruction (BPO) requiring treatment is to be expected and the proportion of patients with cardiovascular comorbidities under anticoagulation is also increasing. As the operative treatment of BPO can be problematic, the hemostatic effect of the techniques is of particular importance. OBJECTIVE: This review article discusses the data situation on the bleeding risk of established surgical techniques and the statement of the European Association of Urology (EAU) guidelines "EAU guidelines on management of non-neurogenic male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO)" on this topic. MATERIAL AND METHODS: Data analysis from PubMed. RESULTS: The EAU guidelines favor transurethral laser vaporization of the prostate using "greenlight", thulium or diode laser and laser enucleation using a holmium or thulium laser in this patient collective. The bipolar is superior to monopolar transurethral resection (TUR-P) in hemostasis. In the future bipolar enucleation of the prostate (BipoLEP) can be an alternative under good hemostasis. Bleeding is a rare complication after recently established minimally invasive techniques, such as Urolift®, I­TIND© and Rezum™, the same applies to prostate artery embolization. Aqua-ablation/AquaBeam® seems to be unsuitable due to frequent hematuria. Surgical adenomectomy can be associated with a high risk of bleeding. CONCLUSION: According to current data, transurethral laser vaporization and enucleation of the prostate are the treatment of choice for patients under anticoagulation; however, other transurethral techniques, such as BipoLEP have an acceptable risk of bleeding and can be an alternative depending on local resources. Newer minimally invasive approaches could become more important in the future.


Assuntos
Terapia a Laser , Hiperplasia Prostática , Ressecção Transuretral da Próstata , Anticoagulantes/efeitos adversos , Humanos , Masculino , Hiperplasia Prostática/complicações , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(37): e22082, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925747

RESUMO

INTRODUCTION: Diabetes insipidus can be a common cause of polyuria and hydronephrosis in the kidneys. However, there is few reported case of urinary obstruction induced nephrogenic diabetes insipidus. PATIENT CONCERNS: A 60-year-old Chinese man came to our hospital with the complaints of polydipsia and polyuria for 1 month. His examination showed chronic kidney disease stage III with eGFR of 48.274 ml/min, and the plasma osmolality was 338.00 mOsm/(kg·H2O) with a urinary osmolality of 163.00 mOsm/(kg·H2O). Moreover, imagological examination of the urinary system showed benign prostatic hyperplasia and hydronephrosis. DIAGNOSIS: He was considered with benign prostatic hyperplasia induced ureter hydronephrosis and nephrogenic diabetes insipidus. INTERVENTIONS: He got the transurethral resection of the prostate to alleviate urinary retention. OUTCOMES: After that, the urine output gradually decreased, and the administered hydrochlorothiazide was stopped due to the improved renal function. CONCLUSION: Our study presents a case of nephrogenic diabetes insipidus caused by urinary obstruction. Differential diagnoses for diabetes insipidus as well as the relationship between nephrogenic diabetes insipidus and urinary obstruction are also considered in this study.


Assuntos
Diabetes Insípido Nefrogênico/etiologia , Hiperplasia Prostática/complicações , Obstrução Ureteral/complicações , Antidiuréticos/uso terapêutico , Desamino Arginina Vasopressina/uso terapêutico , Diabetes Insípido Nefrogênico/diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Pessoa de Meia-Idade , Poliúria/tratamento farmacológico , Hiperplasia Prostática/cirurgia , Ressecção Transuretral da Próstata , Obstrução Ureteral/etiologia
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