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Advances in Surgery for Benign Prostatic Hyperplasia

  • Phil Hyun Song
  • Yeong Uk Kim
Chapter

Abstract

Benign prostatic hyperplasia (BPH) is most commonly observed in men of advancing age. Patients with BPH may experience urinary symptoms. For moderate lower urinary tract symptoms (LUTS), pharmacotherapy is recommended, but many patients have symptom progression and require additional surgical intervention such as transurethral resection of prostate (TURP) or prostatectomy. However, these procedures are still associated with significant perioperative morbidity. As a result, treatment-related complications have led to the development of new technologies for the management of BPH.

Various treatment options include thermoablative strategies, mechanical, water vapor system, and intraprostatic injection. We review the available clinical data with specific emphasis on unique features of the technology, procedural efficacy and safety, and potential impact on current treatment paradigms.

There are new techniques which have been shown to be equivalent to the gold-standard treatment (TURP and prostatectomy), with improvement of LUTS, but significantly fewer adverse effects. Advances in BPH surgery represent a paradigm shift in the treatment of LUTS with BPH. Further studies will help to identify the role of these treatment options for LUTS.

Keywords

Benign prostate hyperplasia TURP Laser surgery Prostate stent Embolization 

References

  1. Aho TF, Gilling PJ. Laser therapy for benign prostatic hyperplasia: a review of recent developments. Curr Opin Urol. 2003;1:39–44.CrossRefGoogle Scholar
  2. Armitage JN, Rashidian A, Cathcart PJ, et al. The thermo-expandable metal stent for managing benign prostatic hyperplasia: a systematic review. BJU Int. 2006;98:806–10.CrossRefGoogle Scholar
  3. Armitage JN, Cathcart PJ, Rashidian A, et al. Epithelializing stent for benign prostatic hyperplasia: a systematic review of the literature. J Urol. 2007;177:1619–24.CrossRefGoogle Scholar
  4. Baer HU, Stain SC, Guastella T, et al. Hepatic resection using a water jet dissector. HPB Surg. 1993;6:189–96.CrossRefGoogle Scholar
  5. Blute ML, Lewis RW. Local microwave hyperthermia as a treatment alternative for benign prostatic hyperplasia. J Androl. 1991;12:429.PubMedGoogle Scholar
  6. Bostwick DG, Larson TR. Transurethral microwave thermal therapy: pathologic findings in the canine prostate. Prostate. 1995;26:116–22.CrossRefGoogle Scholar
  7. Cano FG. Intraprostatic injection of antiseptic substances. Arch Rosales Hosp. 1910.Google Scholar
  8. Chapple CR, Issa MM, Woo H. Transurethral needle ablation (TUNA). A critical review of radiofrequency thermal therapy in the management of benign prostatic hyperplasia. Eur Urol. 1999;35:119–28.CrossRefGoogle Scholar
  9. Chartier-Kastler EJ, Thomas L, Bussel B, et al. A urethral stent for the treatment of detrusor-striated sphincter dyssynergia. BJU Int. 2000;86:52–7.CrossRefGoogle Scholar
  10. Christidis D, McGrath S, Perera M, et al. Minimally invaisve surgical therapies for benign prostatic hypertrophy: the rise in minimally invasive surgical therapies. Prostate Int. 2017;5:41–6.CrossRefGoogle Scholar
  11. Chuang YC, Chiang PH, Yoshimura N, et al. Sustained beneficial effects of intraprostatic botulinum toxin type A on lower urinary tract symptoms and quality of life in men with benign prostatic hyperplasia. BJU Int. 2006;98:1033–7.CrossRefGoogle Scholar
  12. Chung A, Woo HH. What’s truly minimally invasive in benign prostatic hyperplasia surgery? Curr Opin Urol. 2014;24:36–41.CrossRefGoogle Scholar
  13. Corica AP, Larson BT, Sagaz A, et al. A novel temporary prostatic stent for the relief of prostatic urethral obstruction. BJU Int. 2004;93:346–8.CrossRefGoogle Scholar
  14. Denmeade SR, Egerdie B, Steinhoff G, et al. Phase 1 and 2 studies demonstrate the safety and efficacy of intraprostatic injection of PRX302 for the targeted treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Eur Urol. 2011;59:747–54.CrossRefGoogle Scholar
  15. Elhilali MM, Pommerville P, Yocum RC, et al. Prospective, randomized, double-blind, vehicle controlled, multicenter phase IIb clinical trial of the pore forming protein PRX302 for targeted treatment of symptomatic benign prostatic hyperplasia. J Urol. 2013;189:1421–6.CrossRefGoogle Scholar
  16. El-Husseiny T, Buchholz N. Transurethral ethanol ablation of the prostate for symptomatic benign prostatic hyperplasia: long-term follow-up. J Endourol. 2011;25:477–80.CrossRefGoogle Scholar
  17. Eliasson T, Wagrell L. New technologies for the surgical management of symptomatic benign prostatic enlargement: tolerability and morbidity of high energy transurethral microwave thermotherapy. Curr Opin Urol. 2000;10:15–7.CrossRefGoogle Scholar
  18. Elsakka AM, Eltatawy HH, Almekaty KH, et al. A prospective randomized controlled study comparing bipolar plasma vaporization of the prostate to monopolar transurethral resection of the prostate. Arab J Urol. 2016;14:280–6.CrossRefGoogle Scholar
  19. Floratos DL, Sonke GS, Francisca EA, et al. High energy transurethral microwave thermotherapy for the treatment of patients in urinary retention. J Urol. 2000;163:1457–60.CrossRefGoogle Scholar
  20. Gabr AH, Gabr MF, Elmohamady BN, et al. Prostatic artery embolization: a promising technique in the treatment of high-risk patients with benign prostatic hyperplasia. Urol Int. 2016;97:320–4.CrossRefGoogle Scholar
  21. Geavlete B, Stanescu F, Moldoveanu C, et al. Continuous vs conventional bipolar plasma vaporization of the prostate and standard monopolar resection: a prospective, randomized comparison of a new technological advance. BJU Int. 2014;113:288–95.CrossRefGoogle Scholar
  22. Gilling P, Reuther R, Kahokehr A, et al. Image guided robotically-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 2016;117:923–9.CrossRefGoogle Scholar
  23. Gratzke C, Bachmann A, Descazeaud A, et al. EAU guidelines on the assessment of nonneurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2015;67:1099–109.CrossRefGoogle Scholar
  24. Grise P, Plante M, Palmer J, et al. Evaluation of the transurethral ethanol ablation of the prostate (TEAP) for symptomatic benign prostatic hyperplasia (BPH): a European multi-center evaluation. Eur Urol. 2004;46:496–501.CrossRefGoogle Scholar
  25. Hahn DW. Heat conduction. 3rd ed. Hoboken, NJ: Wiley; 2012. p. 718.CrossRefGoogle Scholar
  26. Hedlund H, Ek A. Ejaculation and sexual function after endoscopic bladder neck incision. Br J Urol. 1985;57:164–7.CrossRefGoogle Scholar
  27. Hoffman RM, Monga M, Elliott SP, et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev. 2012;9:Cd004135.Google Scholar
  28. Jones P, Rajkumar GN, Rai BP, et al. Medium-term outcomes of Urolift (minimum 12 months follow-up): evidence from a systematic review. Urology. 2016;97:20–4.CrossRefGoogle Scholar
  29. Kaplan SA, Te AE. Transurethral electrovaporization of the prostate: a novel method for treating men with benign prostatic hyperplasia. Urology. 1995;45:566–72.CrossRefGoogle Scholar
  30. de Kort LM, Kok ET, Jonges TN, et al. Urodynamic effects of transrectal intraprostatic Ona botulinum toxin A injections for symptomatic benign prostatic hyperplasia. Urology. 2012;80:889–93.CrossRefGoogle Scholar
  31. Lourenco T, Shaw M, Fraser C, et al. The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomized controlled trials. World J Urol. 2010;28:23–32.CrossRefGoogle Scholar
  32. Marberger M, Chartier-Kastler E, Egerdie B, et al. A randomized double blind placebo-controlled phase 2 dose-ranging study of onabotulinumtoxin A in men with benign prostatic hyperplasia. Eur Urol. 2013;63:496–503.CrossRefGoogle Scholar
  33. McVary KT, Gange SN, Shore ND, et al. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med. 2014;11:279–87.CrossRefGoogle Scholar
  34. McVary KT, Gange SN, Gittelman MC, et al. Minimally invasive prostate convective water vapor energy ablation: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2016;195:1529–38.CrossRefGoogle Scholar
  35. Meulen T, Zambon JV, Janknegt RA. Treatment of anastomotic strictures and urinary incontinence after radical prostatectomy with UroLume Wallstent and AMS 800 artificial sphincter. J Endourol. 1991;13:517–20.CrossRefGoogle Scholar
  36. Mynderse LA, Hanson D, Robb RA, et al. Rezum system water vapor treatment for lower urinary tract symptoms/benign prostatic hyperplasia: validation of convective thermal energy transfer and characterization with magnetic resonance imaging and 3-dimensional renderings. Urology. 2015;86:122–7.CrossRefGoogle Scholar
  37. Orandi A. Transurethral incision of prostate compared with transurethral resection of prostate in 132 matching cases. J Urol. 1987;138:810–5.CrossRefGoogle Scholar
  38. Ow D, Papa N, Perera M, et al. Trends in the surgical treatment of benign prostatic hyperplasia in a tertiary hospital. ANZ J Surg. 2018;88(1-2):95–9.CrossRefGoogle Scholar
  39. Papatsoris GA, Junaid I, Zachou A, et al. New developments in the use of prostatic stents. Open Access J Urol. 2011;3:63–8.CrossRefGoogle Scholar
  40. Perry MJ, Roodhouse AJ, Gidlow AB, et al. Thermo-expandable intraprostatic stents in bladder outlet obstruction: an 8-year study. BJU Int. 2002;90:216–23.CrossRefGoogle Scholar
  41. Pisco JM, Pinheiro LC, Bilhim T, et al. Prostatic arterial embolization to treat benign prostatic hyperplasia. J Vasc Interv Radiol. 2011;22:11–9.CrossRefGoogle Scholar
  42. Pisco JM, Bilhim T, Pinheiro LC, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27:1115–22.CrossRefGoogle Scholar
  43. Plante MK, Marks LS, Anderson R, et al. Phase I/II examination of transurethral ethanol ablation of the prostate for the treatment of symptomatic benign prostatic hyperplasia. J Urol. 2007;177:1030–5.CrossRefGoogle Scholar
  44. Roberts WW, Teofilovic D, Jahnke RC, et al. Histotripsy of the prostate using a commercial system in a canine model. J Urol. 2014;191:860–5.CrossRefGoogle Scholar
  45. Roehrborn CG, Rukstalis DB, Barkin J, et al. Three year results of the prostatic urethral L.I.F.T. study. Can J Urol. 2015;22:7772–82.PubMedGoogle Scholar
  46. Schulman CC, Zlotta AR, Rasor JS, et al. Transurethral needle ablation (TUNA): safety, feasibility, and tolerance of a new office procedure for treatment of benign prostatic hyperplasia. Eur Urol. 1993;24:415–23.CrossRefGoogle Scholar
  47. Shore N, Cowan B. The potential for NX-1207 in benign prostatic hyperplasia: an update for clinicians. Ther Adv Chronic Dis. 2011;2:377–83.CrossRefGoogle Scholar
  48. Silva J, Pinto R, Carvallho T, et al. Mechanisms of prostate atrophy after glandular botulinum neurotoxin type A injection: an experimental study in the rat. Eur Urol. 2009;56:134–40.CrossRefGoogle Scholar
  49. Sonksen J, Barber NJ, Speakman MJ, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015;68:643–52.CrossRefGoogle Scholar
  50. Talwar GL, Pande SK. Injection treatment of enlarged prostate. Br J Surg. 1966;53:421–7.CrossRefGoogle Scholar
  51. Thalmann GN, Mattei A, Treuthardt C, et al. Transurethral microwave therapy in 200 patients with a minimum follow-up of 2 years: urodynamic and clinical results. J Urol. 2002;167:2496–501.CrossRefGoogle Scholar
  52. Vanderbrink BA, Rastinehad AR, Badlani GH. Prostatic stents for the treatment of benign prostatic hyperplasia. Curr Opin Urol. 2007;17:1–6.CrossRefGoogle Scholar
  53. Woo HH, Chin PT, McNicholas TA, et al. Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). BJU Int. 2011;108:82–8.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Phil Hyun Song
    • 1
  • Yeong Uk Kim
    • 1
  1. 1.Department of Urology, College of MedicineYeungnam UniversityDaeguRepublic of Korea

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