Recent Advances and Emerging Technology in the Surgical Management of BPH-Related Voiding Dysfunction

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• 作者：Karen Stern (1)
  Arthi Satyanarayan (1)
  Joel T. Funk (1)
  
• 关键词：Benign prostatic hyperplasia ; Voiding dysfunction ; Transurethral ; Transurethral resection of the prostate ; TURP ; Lower urinary tract symptoms ; LUTS ; Sexual function ; Comorbid populations ; Laser ; Prostatic arterial embolization ; PAE ; BPH treatment ; BPH ; related voiding dysfunction
• 刊名：Current Bladder Dysfunction Reports
• 出版年：2014
• 出版时间：June 2014
• 年：2014
• 卷：9
• 期：2
• 页码：129-133
• 全文大小：
• 参考文献：1. Roehrborn CG. Chapter 91: Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history, Wein: Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 2570鈥?10.
  2. Roehrborn CG. Benign prostatic hyperplasia and lower urinary tract symptom guidelines. Urol Assoc J. 2012;6:S130.
  3. Roehrborn CG, Gange SN, Shore ND, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. Study. J Urol. 2013;190:2161. / Emerging office based technique recently approved and show to be efficacious for patients either unwilling or unable to undergo anesthetic requiring procedures. CrossRef
  4. Fitzpatrick JM. Chapter 91: Benign prostatic hyperplasia: Etiology, pathophysiology, epidemiology, and natural history, Wein: Campbell-Walsh Urology. 10th ed. Philadelphia: Elsevier Saunders; 2012. p. 2683鈥?.
  5. Geavlete B, Stanescu F, Lacaboaie C, Geavlete P. Bipolar plasma enucleation of the prostate vs open prostatectomy in a large benign prostatic hyperplasia cases 鈥?a medium term, prospective, randomized comparision. BJU Int. 2013;111:793. / Well designed and executed study that demonstrates efficacy of the bipolar technique for larger prostate volumes. With the increasing use of bipolar in the last several years this study demonstrates efficacy and safety. CrossRef
  6. Zhu L, Chen S, Yang S, et al. Electrosurgical enucleation versus bipolar transurethral resection for prostates larger than 70聽ml: a prospective, randomized trial with 5-year followup. J Urol. 2013;189:1426.
  7. Shih HJ, Chen JT, Chen YL, et al. Laser-assisted bipolar transurethral resection of the prostate with the oyster procedure for patients with prostate glands larger than 80聽mL. Urology. 2013;81:1315. CrossRef
  8. Yang SS, Hsieh CH, Chiang IN, et al. Prostate volume did not affect voiding function improvements in diode laser enucleation of the prostate. J Urol. 2013;189:993. / Restrospective study that demonstrated efficacy of diode laser irrespective of prostate volume. Supports expanded use of this laser wavelength for physicians experienced in the use of this laser. CrossRef
  9. Osterberg EC, No D, Otto BJ, et al. A retrospective review of office-based 532-nm GreenLight laser prostatectomy in men with symptomatic benign prostatic hyperplasia. Urology. 2013;82:680. CrossRef
  10. Jaeger CD, Krambeck AE. Holmium laser enucleation of the prostate for persistent lower urinary tract symptoms after prior benign prostatic hyperplasia surgery. Urology. 2013;81:1025. / Important study demonstrating that the technical aspects of HoLEP are surmountable even in patients having undergone prior resection with other modalities and showing excellent symptomatic outcomes when this is undertaken by experienced HoLEP surgeons. CrossRef
  11. Elmansy HM, Kotb A, Elhilali MM. Holmium laser enucleation of the prostate: long-term durability of clinical outcomes and complication rates during 10聽years of follow up. J Urol. 2011;186:1972鈥?. / The longest follow-up study to date with HoLEP. Prospectively collected large series showing superiority demonstrating durability out to 10聽years with extensive and thorough data collection. CrossRef
  12. Yang Z, Wang X, Liu T. Thulium laser enucleation versus plasmakinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology. 2013;81:396. CrossRef
  13. Mamoulakis C, Skolarikos A, Schulze M, et al. Bipolar vs monopolar transurethral resection of the prostate: evaluation of the impact on overall sexual function in an international randomized controlled trial setting. BJU Int. 2013;112:109. CrossRef
  14. Carnavale FC, Motta-Leal-Filho JM, Antunes AA, Baroni RH, Marcelino ASZ, Cerri LMO, et al. Quality of life and clinical symptom improvement support prostatic artery embolization for patients with acute urinary retention caused by benign prostatic hyperplasia. J Vasc Interv Radiol. 2013;24:535鈥?2. / As with the ProLift procedure emerging technology that has the potential to alleviate serve LUTS in patients unwilling or unable to undergo other treatment modalitites. Area of current active research here in the United States but lacking full FDA approval as of this date and further research is required. CrossRef
  15. Tinto HR, Pisco JM, Bilhim T, Duarte M, Fernandes L, Pereira J, et al. Prostatic artery embolization in the treatment of benign prostatic hyperplasia: Short and medium follow-up. Tech Vasc Interv Radiol. 2012;25:290鈥?. CrossRef
  16. Bilhim T, Pisco J, Tinto HR, Fernandes L, Pinheiro LC, Duarte M, et al. Unilateral versus bilateral prostatic artery embolization for lower urinary tract symptoms in patients with prostate enlargement. Cardiovasc Intervent Radiol. 2013;36:403鈥?1. CrossRef
  17. Miller N. Benign prostatic hyperplasia and lower urinary tract symptoms 鈥?when to pull the trigger on surgery? J Urol. 2013;190:1976. CrossRef
  
• 作者单位：Karen Stern (1)
  Arthi Satyanarayan (1)
  Joel T. Funk (1)
  
  1. Division of Urology, University of Arizona School of Medicine, 1501 North Campbell Ave, PO Box 245077, Tucson, AZ, 85724, USA
  
• ISSN：1931-7220

文摘

As transurethral resection of the prostate (TURP) continues to be the standard of care to alleviate voiding dysfunction in men with benign prostatic hyperplasia (BPH), novel techniques are being addressed to promote operative efficacy and long-term results for improved voiding. This review addresses recent literature over the past year on various transurethral technologies and procedures as well as the developing practice of prostatic arterial embolization (PAE) to improve lower urinary tract symptoms in the setting of BPH. The transurethral technologies include bipolarity, which has come to the forefront in the resection of large prostates as it reduces the risk of TUR syndrome, and plasmakinetic enucleation and diode laser enucleation which have both recently been demonstrated to improve tissue resection for larger prostate glands. The Oyster Procedure, described below, is a specific method of adenoma resection which has been demonstrated to be effective in the treatment of large obstructing prostates. HoLEP, which has been established as an effective tool for large prostates, has now been described to be useful in patients requiring retreatment of LUTS secondary to BPH. Prostatic artery embolization (PAE) has recently come to the forefront of a minimally invasive alternative to TURP with a reduction of symptoms and recovery time in patients who have had unsuccessful or refractory treatments for LUTS. While TURP aids in improving voiding dysfunction, it is known to affect sexual function. New implants, such as those explained in the UroLift procedure below, can improve LUTS while preserving sexual function. Finally, The GreenLight laser prostatectomy has now been demonstrated to be safe and effective in an office setting with conscious sedation, thereby reducing surgical risk with anesthesia for those with comorbidities. The studies discussed in this review focus on improving procedures for treating larger prostates, prostates with prior surgical interventions or refractory BPH, patients who wish to maintain sexual function, and assessing interventions for the elderly and those with comorbidities. As new technologies continue to expand, their use among both novice and experienced surgeons will be vital to advancing the treatments for BPH.