术前尿流动力学检查对TURP术后疗效预测的研究

目的: 探讨经尿道前列腺电切术(TURP)术前尿流动力学检查对术后疗效预测的价值。　方法: 对 160例良性前列腺增生(BPH)患者TURP术前、术后 8~11个月尿流动力学检查的参数及国际前列腺症状评分(IPSS)、生活质量评估(QOL)等进行统计学分析。　结果: TURP术后尿流动力学检查的参数(最大尿流率、最大尿流率时逼尿肌压力、Schafer分级、A G值、尿道阻力因子、最大膀胱容量、有效膀胱容量)、IPSS及QOL均明显得到改善 (P<0. 001)。术后IPSS、QOL分别与最大尿流率、最大尿流时逼尿肌压力、Schafer分级、A G值、尿道阻力因子、最大膀胱容量、有效膀胱容量等呈极显著相关或显著相关。　结论: TURP术前尿流动力学检查有助于把握TURP手术指征、能预测术后患者症状改善的程度;TURP术前尿流动力学检查应列为重要检查项目,以杜绝手术的盲目性及预测术后疗效。     

A PROSPECTIVE, RANDOMIZED 1-YEAR CLINICAL TRIAL COMPARING TRANSURETHRAL NEEDLE ABLATION TO TRANSURETHRAL RESECTION OF THE PROSTATE FOR THE TREATMENT OF SYMPTOMATIC BENIGN PROSTATIC HYPERPLASIA

Purpose

We assess the 1-year efficacy and safety of transurethral needle ablation of the prostate compared to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia (BPH).

Materials and Methods

A prospective, randomized clinical trial of 121 men 50 years old or older with symptomatic BPH was performed at 7 medical centers across the United States. Of the men 65 (54%) were treated with transurethral needle ablation of the prostate and 56 (46%) underwent transurethral resection of the prostate. Mean and percentage changes from baseline and between cohorts for American Urological Association (AUA) symptom score, AUA bother score, quality of life score, peak urinary flow rate and post-void residual urine volume were measured at 1, 3, 6 and 12 months following treatment. Length of procedure, hospitalization, type of anesthesia, post-procedure catheterization, side effects and sexual function were compared.

Results

Transurethral needle ablation and resection resulted in a statistically significant improvement in AUA symptom, bother and quality of life scores, peak urinary flow rate and post-void residual. At 1-year followup, needle ablation and resection were equally effective in enhancing quality of life. Needle ablation had less effect on sexual function, with resection being associated with a greater incidence of retrograde ejaculation. Needle ablation could be performed as an outpatient procedure with local anesthesia while resection required anesthesia and hospitalization. Needle ablation was associated with markedly fewer side effects than resection.

Conclusions

Compared to transurethral resection of the prostate, transurethral needle ablation of the prostate is an efficacious, minimally invasive treatment for symptomatic BPH that is associated with few side effects.     

Transurethral Needle Ablation of the Prostate: Report of Initial United States Clinical Trial

Purpose

We studied the efficacy and safety of transurethral needle ablation of the prostate for treatment of symptomatic benign prostatic hyperplasia (BPH).

Materials and Methods

A total of 12 patients with symptomatic BPH underwent transurethral needle ablation of the prostate. Voiding outcomes, including American Urological Association symptom scores, bother scores, quality of life scores, peak urinary flow rates, residual urine volumes and urodynamic pressure flows, were measured with time, and immediate and short-term (6 months) complications were assessed.

Results

Transurethral needle ablation of the prostate was performed with local intraurethral lidocaine anesthesia in 11 patients and general anesthesia in 1. At 6 months there was a 61.7 percent improvement in American Urological Association symptom score (25.6 to 9.8, p = 0.0001), 61.1 percent improvement in bother score (18.8 to 7.3, p = 0.0002), 70.0 percent improvement in quality of life score (13.7 to 4.1, p = 0.0001), 73.0 percent increase in peak flow rate (7.8 to 13.5 cc per second, p less than 0.0001) and 54.9 percent decrease in the post-void residual (111 to 50 cc, p = 0.0457). Prostate volumes, maximum detrusor pressures and detrusor opening pressures decreased significantly. There were no intraoperative complications. Postoperatively, all 12 patients had mild dysuria for 1 to 7 days, 5 had transient urinary retention for 1 to 4 days, 3 had hematuria for 1 to 2 days and 1 had retrograde ejaculation.

Conclusions

This initial United States trial confirms previous experience, and shows that transurethral needle ablation of the prostate appears to be a simple, safe and efficacious procedure for treatment of symptomatic BPH. In addition, it can be performed in the majority of patients using topical urethral anesthesia.     

Single-blind, randomized controlled study of the clinical and urodynamic effects of an α-blocker (naftopidil) and phytotherapy (eviprostat) in the treatment of benign prostatic hyperplasia

AIM: The aim of our study was to examine the efficacy of naftopidil in terms of the international prostate symptom score (IPSS) and urodynamic parameters in the treatment of benign prostatic hyperplasia (BPH). Eviprostat was used as a control to study the efficacy of naftopidil. METHODS: Forty-nine patients with BPH (mean age 67.9 +/- 7.8 years) were involved in the study. Patients were randomly assigned either to the naftopidil group, which was treated with the alpha-blocker naftopidil (50-75 mg daily, 36 patients), or the eviprostat group, which was treated with phytotherapy (six tablets of eviprostat daily, 13 patients). RESULTS: The mean total IPSS, the total storage and voiding symptom scores, and the quality of life score decreased significantly (P < 0.0001 for each variable) in the naftopidil group, but not in the eviprostat group. In the naftopidil group, analyses showed significant increases in average and maximum flow rate and bladder capacity at first desire to void (P < 0.001, P = 0.001 and P = 0.024, respectively), and significant decreases in the postvoid residual, the percent of residual and the Abrams-Griffiths number (P = 0.009, P = 0.008 and P = 0.042, respectively). However, in the eviprostat group, no significant changes were noted in terms of these symptomatic and urodynamic parameters. In the pressure/flow study, an improvement in the International Continence Society nomogram grade was noted in 29% of the naftopidil group, but in only 16% of the eviprostat group. Among the 14 patients in the naftopidil group, detrusor overactivity disappeared in 21% and cystometric capacity increased in 36%, but no improvement in detrusor overactivity was noted in the eviprostat group. CONCLUSIONS: Naftopidil appears to have been effective in this short-term treatment of BPH.     

A randomized controlled trial comparing transurethral resection of the prostate,contact laser prostatectomy and electrovaporization in men with benign prostatic hyperplasia: urodynamic effects

PURPOSE: We compared urodynamic and uroflowmetry improvements in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH) after transurethral prostate resection, contact laser prostatectomy and electrovaporization. MATERIALS AND METHODS: A prospective randomized controlled trial was performed in men with lower urinary tract symptoms suggestive of BPH who met the criteria of the International Scientific Committee on BPH, had a prostate volume of between 20 and 65 ml., and a Sch?fer obstruction grade of 2 or greater. Before and 6 months after treatment urodynamics and free uroflowmetry were performed. RESULTS: A total of 50, 45 and 46 men were randomized to transurethral prostate resection, laser treatment and electrovaporization, respectively. Baseline characteristics were similar in the 3 groups. Detrusor contractility did not change in any of the treatment groups. The average maximum free flow rate increased by a factor of 2.4 after transurethral prostate resection, 2.5 after laser prostatectomy and 2.4 after electrovaporization. The Sch?fer obstruction grade decreased by a factor of 0.3 in all groups. Obstruction (Sch?fer grade greater than 2) was not noted after transurethral prostate resection or electrovaporization but it was evident in 2 patients after laser prostatectomy. Effective capacity increased by a factor of 1.5 or more. The incidence of detrusor instability was decreased by half in all groups. The incidence of significant post-void residual urine volume decreased in all groups. CONCLUSIONS: There were no significant differences in the improvement in urodynamic and uroflowmetry parameters 6 months after treatment when comparing transurethral prostate resection, contact laser prostatectomy and electrovaporization in men with lower urinary tract symptoms suggestive of BPH.     

URODYNAMIC EFFECTS OF VARIOUS TREATMENT MODALITIES FOR BENIGN PROSTATIC HYPERPLASIA

Purpose

I studied the effects of various treatments for benign prostatic hyperplasia on urethral resistance.

Materials and Methods

I reviewed the literature on urodynamic effects of treatments for benign prostatic hyperplasia. Articles that reported pretreatment and posttreatment values of relevant urodynamic parameters were analyzed. Average before and after treatment values of maximum flow rate and detrusor pressure at maximal flow rate for every study were plotted on an Abrams-Griffiths nomogram and classified as obstructed, equivocal or nonobstructed. Average values of maximum flow rate and detrusor pressure at maximal flow rate were calculated for the total number of patients treated by a certain modality.

Results

Based on this analysis, the rank order of urodynamic efficacy was that open prostatectomy is more effective in reducing urethral resistance than is transurethral prostatectomy. These treatments diminish obstruction better than laser treatment or transurethral incision of the prostate, which again are more effective than balloon dilation, alpha-blockers or transurethral microwave thermotherapy. Finally, androgen deprivation performs better than placebo treatment.

Conclusions

The rank order of urodynamic efficacy as determined in this analysis shows a high level of agreement with reported rank order of symptomatic efficacy of various modalities. After placebo treatment there is no significant change in urethral resistance. This finding indicates that pressure-flow studies are a sensitive way to compare active to placebo treatment and that pressure-flow studies have excellent long-term reproducibility.     

Urodynamic indices change as a result of transrectal microwave thermotherapy (TMT) in benign prostatic hyperplasia (BPH)

Fifty-three patients with BPH have been evaluated and treated with TMT with a follow-up at 7 months. The prostate was heated transcrectally to 42–43°C and the treatment consisted of 5 to 6 sessions. The duration of each session was 60 minutes. The urodynamic parameters studied revealed an increase of the maximum flow rate and a decrease of the detrusor opening pressure as well as the detrusor pressure at maximum flow. A significant improvement in the amount of residual urine was seen in all patients. Based on the above, we propose TMT as a viable alternative to open surgical or transurethral removal of the prostate. Futhermore, TMT may serve as a preferred treatment option in patients with indwelling urethral catheters and highly increased surgical risk.     

Detrusor instability with equivocal obstruction: A predictor of unfavorable symptomatic outcomes after transurethral prostatectomy

AIMS: To elucidate whether preoperative urodynamic findings can predict outcomes of transurethral resection of the prostate (TUR-P). METHODS: Sixty-two patients with symptomatic benign prostatic hyperplasia were categorized in three different ways based on findings of preoperative pressure-flow study (PFS) and cystometry: urodynamic obstruction (determined by the Abrams-Griffiths nomogram), detrusor instability (DI), and combination of both. Outcomes of TUR-P regarding symptom, function, and quality of life (QOL) were analyzed by changes in the International Prostate Symptom Score (I-PSS), maximum flow rate in uroflowmetry, and QOL index before and after TUR-P, respectively. Overall outcome was defined as success when all of the three categories showed successful improvement. RESULTS: Neither urodynamic obstruction alone nor DI alone predicted outcomes of TUR-P. However, symptomatic and overall outcomes were significantly worse in patients who were not obstructed but had DI. Postoperative persistent DI was more frequently noted in patients without clear obstruction (60%) than in those with obstruction (27%). Patients with equivocal obstruction showed less satisfactory symptomatic outcomes of TUR-P when DI was accompanied. Persistent DI might be the principle cause of unfavorable outcomes. CONCLUSIONS: Preoperative evaluation of DI is of benefit because it enhances predictive value of the PFS.     

前列腺增生合并组织学炎症患者临床及尿动力学特征分析

目的探讨前列腺增生（BPH）合并组织学前列腺炎（HP）患者的临床及尿动力学特征.方法：将189例BPH接受经尿道逆行前列腺电切术治疗的患者,依据病理诊断分为单纯BPH组和BPH合并HP组,在匹配年龄、体重指数和前列腺体积后,每组38例;比较两组国际前列腺症状评分（IPSS）、最大尿流率、最大膀胱容量、残余尿量、最大逼尿肌压力和最大尿道压力等尿动力学指标,以及膀胱逼尿肌过度活动发生率间的差异.结果：与单纯BPH组相比,BPH合并HP组具有更高的IPSS总分和IPSS储尿期评分（P 〈 0.05）,较小的最大膀胱容量（P 〈 0.001）和更高的膀胱逼尿肌过度活动的发生率（P 〈 0.05）.结论：合并HP会加重BPH患者的储尿期症状,导致尿动力学中最大膀胱容量的降低和逼尿肌过度活动的发生.     

Transrectal Microwave Hyperthermia for Patients with Benign Prostatic Hyperplasia

Background:
A randomized study evaluated the efficacy of treatment with transrectal microwave hyperthermia (TMH) treatment in patients with benign prostatic hyperplasia (BPH).
Methods:
Eighty BPH patients received TMH therapy and 20 patients were given a sham treatment. TMH was achieved using a prostathermer which includes a microwave transrectal heat generator, a cooling system and a transurethral sensor probe. Patients that received TMH had 5 to 6 sessions of 1 hour each where the prostate was heated to 42°C to 43.5°C. The sham treatment consisted of a single session where the temperature was maintained at 37°. All patients were evaluated at 3 and 12 months after treatment.
Results:
There was an improvement of subjective obstructive symptoms in 54 patients (75%) after TMH. An evaluation of urodynamic parameters revealed an increase in the maximum flow rate and a decrease of the detrusor opening pressure as well as the detrusor pressure at maximum flow in patients treated with TMH. A significant improvement in the amount of residual urine was seen in all TMH-treated patients ( P <0.0001).
Conclusion:
Although TMH cannot be considered a superior alternative to open surgical or transurethral excision of the prostate, it is a valid option for patients who have indwelling urethral catheters and for those at high surgical risk.     

Prospective urodynamic evaluation of the efficacy of prostatic balloon dilatation

In order to evaluate the ability of transurethral prostatie balloon dilatation (TUPBD) to effectively treat prostatic obstruction, 18 men (aged 53–77 years) with obstructive small prostate glands were evaluated with symptom scores and urodynamic studies before and 6 and 12 months after TUPBD utilizing the endoscopically placed Advanced Surgical Intervention 75F balloon. After TUPBD, 81% of men reported some improvement in their symptoms with statistical significance (P <.05) at 6 and 12 months after the procedure. The mean non-invasive peak flow rate did not change significantly after TUPBD. Although the mean maximum voiding pressure (Pv max) and the maximum detrusor pressure at peak flow (Pq max) were reduced at 6 and 12 months postoperatively, the changes were found to be statistically insignificant (P >.05). In addition, the use of Abrams and Griffiths pressure-flow nomogram revealed a “non-obstructive” pressure-flow study in only one patient at 6 and 12 after TUPBD. Although TUPBD results in some symptomatic improvement, on pressure-flow analysis the majority of men remain obstructed at 6 and 12 months after the procedure.     

Long-term results of contact laser versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia with small or moderately enlarged prostates

OBJECTIVE: To evaluate the long-term results of contact laser vaporization (CLV) of the prostate and transurethral resection of the prostate (TURP) in patients with symptomatic bladder outflow obstruction (BOO) caused by benign prostatic hyperplasia (BPH) with prostates smaller than 40 ml. MATERIAL AND METHODS: A total of 52 patients with lower urinary tract symptoms (LUTS) and urodynamically confirmed BOO caused by BPH with glands smaller than 40 ml were treated by means of CLV or TURP in a randomized trial. Changes in symptom score, urodynamics and prostate volume were evaluated during a 4-year follow-up period. RESULTS: A total of 42 (81%) of the patients were available for review at 4 years. The re-operation rate was 1/26 for each treatment. A sustained improvement in median Danish Prostate Symptom Score was seen in the laser group from 18 (range 5-54) to 5 (0-34) and in the TURP group from 18 (4-46) to 4 (0-18) (p<0.001 for both). A sustained improvement in maximum urinary flow rate was also seen in the laser group from 8.3 (4.8-19.6) ml/s to 14.3 (10.1-33.6) ml/s (p<0.001) and in the TURP group from 8.6 (5.0-15.9) ml/s to 16.1 (7.7-39.6) ml/s (p<0.01), without differences between the study groups. Median detrusor pressure at maximum urinary flow rate decreased significantly after both treatments, in the CLV group from 64 (32-112) cmH2O to 38 (18-65) cmH2O and in the TURP group from 57 (40-137) cmH2O to 28 (9-44) cmH2O (p<0.001 for both), and at 48 months was significantly higher in the laser group (p<0.01). At 4 years, 7/22 (32%) of the laser patients and 2/20 (10%) of the TURP patients were urodynamically obstructed. Post-void residual at 48 months was significantly lower in the TURP group than in the CLV group. Median prostate volume was smaller after TURP at 6 and 48 months (p<0.05). CONCLUSIONS: Long-term data of CLV and TURP treatments for BPH with small or moderately enlarged prostates indicate no significant difference in the relief of symptoms or in the rate of re-operations. However, the number of patients in this study was small and consequently the power to detect differences between the study groups was low. Regarding most objective outcome parameters, long-term follow-up revealed a slight advantage of TURP over CLV.     

Outcome of Vaportrode Transurethral Vaporization of the Prostate Using Pressure-Flow Urodynamic Criteria

Objectives. To use pressure-flow urodynamic parameters to evaluate the outcome of patients with benign prostatic hyperplasia (BPH) who were treated with transurethral vaporization of the prostate (TUVP) using the Vaportrode.Methods. Forty consecutive patients (mean age 71.7 years) undergoing TUVP for treatment of symptomatic obstructive BPH or urinary retention were evaluated preoperatively and postoperatively with American Urological Association (AUA) Symptom Score, uroflowmetry, and pressure-flow multichannel urodynamic studies.Results. Twenty-nine patients were voiding preoperatively. Eleven patients presented with urinary retention and were analyzed separately. At 3-month mean follow-up, the AUA Symptom Score decreased from 20.7 to 7.2 (n = 26). Peak uroflow rate (Qmax) increased from 8.2 to 15.5 mL/s (n = 27), whereas detrusor pressure at maximal flow (Pdet) decreased from 95.0 to 44.7 cm H₂O (n = 24), indicating relief of obstruction. Postvoid residual urine volume decreased from 181.8 to 37.3 mL (n = 27). At 1-year mean follow-up, the AUA Symptom Score was 5.6 (n = 15) and Qmax was 14.3 mL/s (n = 19). The overall complication rate was 17.5% and included meatal stenosis (n = 1), bulbar urethral stricture (n = 1), refractory detrusor hyperreflexia (n = 1), dystrophic bladder neck calcification (n = 1), prostatic synechial formation requiring revision (n = 2), and residual prostatic tissue requiring revision (n = 1).Conclusions. This study provides objective evidence that TUVP is effective in providing prompt relief of bladder outlet obstruction with durable improvement in symptoms and flow rate with no acute morbidity. Accordingly, TUVP should continue to be considered as a minimally invasive surgical alternative to transurethral resection of the prostate.     

Predictive value of low maximum flow rate in benign prostatic hyperplasia

Among 84 patients with prostatism selected for transurethral resection of the prostate, 18 had a maximum flow at spontaneous uroflowmetry less than or equal to 7 ml/sec. Preoperatively there was no significant difference between patients with maximum flow less than or equal to 7 ml/sec (Group 1) and patients with maximum flow greater than 7 ml/sec (Group 2) in age, duration of symptoms, symptom scores, bladder volume, residual urine, and detrusor pressure at maximum flow. Patients in Group 1, however, had significantly lower urethral resistance and bladder volume independent maximum flow than patients in Group 2. Postoperatively, patients with preoperative maximum flow less than or equal to 7 ml/sec improved significantly in symptom scores and urodynamic findings apart from bladder volume and detrusor pressure at maximum flow. There were no significant differences between groups in postoperative symptom scores or urodynamic findings. We conclude that preoperative maximum flow rates less than or equal to 7 ml/sec at spontaneous uroflowmetry were related to high urethral resistance and not detrusor decompensation among patients with prostatism, and that patients with maximum flow rates less than or equal to 7 ml/sec fared as well postoperatively as patients with maximum flow greater than 7 ml/sec.     

Urodynamic effects of terazosin treatment for Japanese patients with symptomatic benign prostatic hyperplasia

PURPOSE: For treating benign prostatic hyperplasia (BPH) 5 or 10 mg. terazosin hydrochloride daily has been routinely used in North America and Europe. We investigated the urodynamic effects of 2 mg. terazosin daily on Japanese patients with symptomatic BPH using pressure flow study. MATERIALS AND METHODS: A total of 20 Japanese patients 50 years old or older with symptomatic BPH underwent symptomatic and urodynamic evaluations, including pressure flow study, before and after terazosin treatment. Patients were given 1 mg. terazosin once daily for the first 7 days and they continued to receive 1 mg. terazosin twice daily for the following 3 weeks. RESULTS: At 4 weeks after terazosin treatment the International Prostate Symptom Score, quality of life index and maximum and average flow rates were significantly improved. Pressure flow study demonstrated decreased detrusor pressure at maximum flow, and minimum detrusor pressure during voiding and urethral resistance factor after terazosin treatment. Of the 20 patients 13 (65%) showed improvement in the linear passive urethral resistance relation. There was no significant difference in the maximum W. factor before and after terazosin treatment. CONCLUSIONS: Terazosin treatment, even 2 mg. daily, urodynamically relieved bladder outlet obstruction in Japanese patients with symptomatic BPH without any changes in detrusor contractility.     

FURTHER EVALUATION OF TRANSURETHRAL LASER ABLATION OF THE PROSTATE IN PATIENTS TREATED WITH ANTICOAGULANT THERAPY

Transurethral Nd: YAG laser ablation of the prostate gland was used to treat benign prostatic hyperplasia (BPH) in 20 patients on Warfarin anticoagulant therapy, and in two patients with abnormal coagulation parameters secondary to haematologic disorders. Preliminary results for the first 10 of these patients has been reported previously. The mean pre-operative international normalized ratio (INR) was 2.6 (range 1.19 to 5.25) and the mean prostate volume was 56cc (13.6–112cc). All patients had significant subjective and objective indicators of prostatic obstruction and six patients were in urinary retention. Postoperative improvement in symptom score, maximum flow rate and post-void residual was noted in 82% of patients at 3 months, 89% at 6 months and 75% at 1 year. Two patients have required revision laser or transurethral resection of the prostate (TURP) for persistent obstruction. while one patient required revision TURP for intractable haematuria. Three patients developed haematuria requiring transfusion while four patients had mild haematuria requiring no intervention. Laser ablation of the prostate can be used successfully and safely to treat prostatic obstruction in patients with abnormal coagulation parameters, or in those who are fully anticoagulated. Anticoagulation can be maintained during surgery in this group unlike TURP where pre-operative reversal is necessary with reinstitution of therapy several days postoperatively. Other authors report at least a 50% blood transfusion rate in this group. Laser prostatectomy appears the more appealing surgical option in these patients.     

Urodynamically diagnosed detrusor hypocontractility: should transurethral resection of the prostate be contraindicated?

Background  

Patients with benign prostatic hyperplasia (BPH) suffering from hypocontractile detrusor were generally regarded unsuitable for surgery. This prospective study is to evaluate the efficacy of transurethral resection of the prostate (TURP) on BPH patients diagnosed detrusor hypocontractility on urodynamic study (UDs).     

CATHETER-FREE ENDOSCOPIC LASER ABLATION OF THE PROSTATE USING A 1-SIZE PROSTATIC STENT

Purpose

Endoscopic laser ablation of the prostate is a safe alternative to transurethral prostatic resection. Recognized disadvantages include prolonged catheterization, postoperative discomfort and delayed symptomatic improvement. We assessed the role of a 1-size temporary prostatic stent in men undergoing endoscopic laser ablation of the prostate.

Materials and Methods

A total of 55 men a mean of 73 years old with outflow obstruction, including 9 who presented in urinary retention, underwent endoscopic laser ablation of the prostate and temporary stenting. Urinary flow rate, residual urine volume, symptom score and prostate specific antigen were measured preoperatively, and 6 weeks (with the stent in situ), 3 months (after stent removal) and 12 months postoperatively. Duration of hospital stay and complications were also recorded.

Results

Of the 55 men 37 (67%) voided immediately with the stent in situ, including 7 of the 9 in retention. At 6 weeks with the stent in place mean maximum urine flow was 17.3 ml. per second (preoperatively 8.7). Dysuria was reported by 3 patients. Stent related complications were rare. One stent migrated early, resulting in urinary retention, while 2 that migrated late were asymptomatic. No patient had acute urinary retention after stent removal. Maximum urinary flow rate measured at 6 weeks with the stent in situ was similar to that 1 year after endoscopic laser ablation of the prostate.

Conclusions

The use of a 1-size, inexpensive plastic prostatic stent enabled catheter-free endoscopic laser ablation of the prostate in 67% of our patients. Early improvements in the urinary flow rate and a lower incidence of dysuria were additional benefits. The result of endoscopic laser ablation of the prostate at 1 year was comparable to that of transurethral prostatic resection.     

Transurethral holmium laser resection of the prostate

PURPOSE: We evaluated the efficacy of the holmium:YAG laser for transurethral endoscopic prostatectomy for benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We treated 103 patients with BPH with holmium:YAG laser resection of the prostate. A high power holmium laser generating a maximum of 60 or 81 W. was used in a pulsed mode, applying energy directly to prostatic tissue via a forward firing 550 micron. fiber transurethrally under direct vision. Treatment outcome was evaluated by the International Prostate Symptom Score, quality of life score, maximum flow rate and post-void residual urine volume. We also compared holmium laser surgery and transurethral resection of the prostate for operative factors, such as surgical duration, bleeding volume and catheterization time. RESULTS: Average symptom score, quality of life score, peak flow rate and post-void residual significantly improved at 1 week, 1 month and 3 months postoperatively, with improvement maintained up to 36 months postoperatively in the holmium:YAG group. Intraoperative bleeding volume was significantly lower and catheterization time was significantly shorter for holmium:YAG than for transurethral prostatic resection. Use of the holmium laser caused no complications. CONCLUSIONS: Because of its effectiveness and safety holmium:YAG resection is a viable potential surgical alternative for symptomatic BPH. The holmium:YAG laser has been verified to be useful for many purposes in urology.     

Transurethral incision of the prostate: a preoperative and postoperative analysis of symptoms and urodynamic findings

The efficacy of transurethral incision of the prostate was evaluated prospectively in 26 men with urodynamic evidence of outlet obstruction secondary to small prostate glands (estimated size less than 30 gm). All men completed preoperative and postoperative symptom questionnaires and extensive urodynamic testing with a median postoperative followup of 16.25 months. There was a significant improvement in subjective symptom analysis and objective urodynamic parameters (peak and mean uroflow rates, maximal detrusor pressure at peak flow, volume at first urge and post-void residual volume) as a result of transurethral incision of the prostate with minimal postoperative morbidity. Antegrade ejaculation was preserved in 55% of the men with normal preoperative ejaculation. Based on subjective and objective criteria, transurethral incision of the prostate is an effective treatment option for selected men with outlet obstruction.