Evaluation of mid-term results of bipolar transurethral resection in the treatment of benign prostatic hyperplasia

2018 ◽  
pp. 1-9
Author(s):  
А.С. Векильян
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Blood Loss ◽  
Endoscopic Surgery ◽  
Transurethral Resection ◽  
Operating Time ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Surgical Methods

Представлены клинические результаты хирургического лечения доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом до 100 см3 методом биполярной трансуретральной резекции простаты (БТУР -74 пациента) в сравнении с открытой чреспузырной простатэктомией (ОПЭ - 96 пациентов), ранее применявшейся для подобных клинических случаев в урологической клинике "Железнодорожной больницы" г. Волгоград. При статистически равном операционном времени обоих хирургических методов для БТУР отмечено существенное снижение интраоперационной кровопотери, сроков послеоперационной катетеризации и пребывания в стационаре, минимальная частота геморрагических и инфекционно-воспалительных осложнений. Наблюдение за урологическим статусом пациентов в течение первого послеоперационного года показало одинаковую клиническую эффективность сравниваемых хирургических методов. Значительное снижение объема кровопотери в ходе операции БТУР можно считать большим достижением, поскольку улучшение видимости в зоне хирургического вмешательства позволяет оптимизировать гемостаз, предотвратить массивные кровотечения как во время, так и после операции, сократить сроки послеоперационной катетеризации мочевого пузыря, что в свою очередь, снижает частоту развития инфекционно-воспалительных осложнений. Более быстрое восстановление пациентов после эндоскопических операций имеет медико-социальное и экономическое значение, поскольку минимальное количество послеоперационных осложнений и сокращение сроков госпитализации позволяет существенно снизить затраты на лечение и быстрее нормализовать качество жизни пациентов. Полученные результаты демонстрируют перспективность внедрения биполярных методов эндоскопических операций для лечения ДГПЖ в хирургическую практику урологических стационаров в целях повышения безопасности оперативного лечения и экономии затрат на госпитализацию. The clinical results of surgical treatment of benign prostatic hyperplasia (BPH) up to 100 cm3 by bipolar transurethral resection of the prostate (BTUR - 74 patients) in comparison with open transvesical prostatectomy (OPE - 96 patients), previously used for such clinical cases in the urological clinic "Railway hospital" in Volgograd are presented. With statistically equal operating time of both surgical methods, there was a significant decrease in intraoperative blood loss, the terms of postoperative catheterization and hospital stay, the minimum frequency of hemorrhagic and infectious-inflammatory complications. Observation of the urological status of patients during the first postoperative year showed the same clinical efficacy of the compared surgical methods. A significant reduction in the volume of blood loss during the operation, can be considered a great achievement, since the improvement of visibility in the area of surgical intervention allows to optimize the hemostasis, to prevent massive bleeding during and after surgery, to reduce the duration of postoperative bladder catheterization, which, in turn, reduces the incidence of infectious-inflammatory complications. Faster recovery of patients after endoscopic surgery of medical,social and economic importance, as the minimum number of postoperative complications and reduction of hospitalization can significantly reduce the cost of treatment and quickly normalize the quality of life of patients. The results demonstrate the prospects of the introduction of bipolar methods of endoscopic surgery for the treatment of BPH in the surgical practice of urological hospitals in order to improve the safety of surgical treatment and save costs for hospitalization.

LASER TECHNOLOGIES IN SURGERY BENEFICIAL PROSTATE HYPERPLASIA

2021 ◽  
pp. 144-153
Author(s):  
Rakhimov S.A. ◽  
Feofilov I.V. ◽  
Arbuzov I.A.
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Transurethral Resection ◽  
Prostate Gland ◽  
Prostatic Hyperplasia ◽  
Prostate Hyperplasia ◽  
Advantages And Disadvantages ◽  
Laser Technologies ◽  
Surgical Methods ◽  
Laser Systems

Benign prostatic hyperplasia is one of the most common diseases in urological practice. The classical method of surgical treatment of benign prostatic hyperplasia is transurethral resection of the prostate gland. However, this operation is accompanied by a fairly large number of postoperative complications and is not recommended for patients with a large prostate volume, with a high cardiovascular risk, and receiving anticoagulant therapy. In recent years, the medical community has been paying close attention to laser technologies. The article provides an overview of the literature on laser methods for the treatment of benign prostatic hyperplasia. Modern laser systems are considered: holmium, thulium, diode, «green» lasers. The advantages and disadvantages of each technique are described. The results of studies of the efficacy and safety of laser surgical methods for the treatment of benign prostatic hyperplasia and their influence on the indicators of urodynamics, symptoms of the disease, and the quality of life of patients are presented. Based on the analysis of scientific literature sources, it was concluded that laser methods of surgical treatment of benign prostatic hyperplasia are clinically effective and safe. Compared with transurethral resection of the prostate, laser technologies can shorten the period of hospitalization and catheterization of patients, have a low number of complications, provide good hemostasis, and can be used regardless of the volume of the gland in patients with concomitant diseases who are taking anticoagulants. Laser methods of surgical treatment of benign prostatic hyperplasia are currently a full-fledged worthy alternative to transurethral resection of the prostate gland. Among the disadvantages of using laser systems are the duration of the operation and the need to train specialists in the technique of surgical intervention.

The advantages of bipolar transurethral enucleation for the treatment of benign prostatic hyperplasia of large size

2018 ◽  
pp. 21-30
Author(s):  
А.В. Кузнецов ◽  
И.В. Ларичев ◽  
А.Ю. Попова
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Clinical Results ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
Control Group ◽  
Medium Term ◽  
Total Period ◽  
Large Size ◽  
The City

Представлена оценка среднесрочных клинических результатов внедрения биполярной техники выполнения трансуретральной энуклеации (ТУЭБ) доброкачественной гиперплазии предстательной железы (ДГПЖ) объемом свыше 80 см3. Исследование проведено на базе урологического отделения «Дорожной клинической больницы на станции Воронеж-1 ОАО «РЖД» города Воронежа, где применение метода ТУЭБ для хирургического лечения ДГПЖ началось с 2016г. В исследование включено 67 пациентов (основная группа), оперированных методом ТУЭБ, и 79 – методом открытой чреспузырной простатэктомии (ОПЭ, контрольная группа). Применение ТУЭБ позволило в 3 раза сократить срок послеоперационной катетеризации и в 2 раза - объем кровопотери во время операции и общий срок госпитализации. При этом количество операционных осложнений было достоверно меньшим в сравнении с ОЧПЭ, а показатели эффективности оперативного лечения статистически равные. Полученные результаты позволили рекомендовать метод ТУЭБ к широкому применению в урологических клиниках в качестве стандарта хирургического лечения ДГПЖ крупных размеров. Эндоскопический аналог открытой операции следует активно внедрять в хирургическую практику лечения ДГПЖ, что позволит снизить инвазивность оперативного лечения за счет уменьшения риска развития массивных кровотечений и многих других осложнений, а также повысить эффективность использования профильного коечного фонда и экономить средства стационара за счет сокращения продолжительности госпитализации. The evaluation of the medium-term clinical results of the introduction of bipolar technique of transurethral enucleation (TUEB) of benign prostatic hyperplasia (BPH) with a volume of more than 80 cm3 is presented. A study conducted at the urology Department of the clinical hospital at the station Voronezh-1 JSC "RZD" of the city of Voronezh, where the application of the method of TWEB for surgical treatment of BPH began with 2016. The study included 67 patients (main group) were operated by TUEB and 79 by the method of open transvesical prostatectomy (OTP, control group). The use of TUEB made it possible to reduce the period of postoperative catheterization by 3 times and the volume of blood loss during the operation and the total period of hospitalization by 2 times. At the same time, the number of surgical complications was significantly lower in comparison with OTPE, and the indicators of the effectiveness of surgical treatment were statistically equal. The obtained results made it possible to recommend the TUEB method for wide application in urological clinics as a standard of surgical treatment of large-size BPH. The endoscopic analogue of open surgery should be actively introduced into surgical practice of treatment of BPH, which will reduce the invasiveness of surgical treatment by reducing the risk of massive bleeding and many other complications.

scholarly journals Transurethral Resection (TURP) Versus Transurethral Incision (TUIP) of the Prostate for Small Sized Benign Prostatic Hyperplasia: A Prospective Randomized Study

1970 ◽  
Vol 19 (2) ◽  
pp. 50-56
Author(s):  
ABM Golam Robbani ◽  
MA Salam ◽  
AKM Anowarul Islam
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Blood Transfusion ◽  
Hospital Stay ◽  
Transurethral Resection ◽  
Randomized Study ◽  
Operating Time ◽  
Prostatic Hyperplasia ◽  
Prospective Randomized Study ◽  
Irrigation Fluid ◽  
Transurethral Incision

 In a prospective, randomized study, 80 patients with lower urinary tract symptoms (LUTS) caused by small prostate gland (estimated weight <30gm) had either transurethral resection (TURP, n=40) or transurethral incision (TUIP, n=40) of prostate. The study was conducted in the Department of Urology, BSMMU, Dhaka and Rajshahi Medical College Hospital, Rajshahi. Aims of the study were to evaluate the efficacy of TUIP as a treatment modality for small size obstructive BPH and to compare its outcome with that of TURP. A relative advantage of TUIP over conventional TURP was also observed in this study. Preoperative variables (symptom scores, PVR, uroflowmetry parameters) were well matched in between TURP and TUIP group.TURPs were done in conventional technique. For TUIP, two deep incisions were made at 5- and 7-0'clock positions of the bladder neck using Colling's knife. Operative variables (operating time, amount of irrigation fluid and blood transfusion required) were observed and recorded. Postoperative catheterization period and hospital stay (in days) were noted.All patients were followed up at 3 to 4 months postoperatively. Changes of preoperative variables following surgery were assessed. Sexual functions were also questioned and noted pre- and postoperatively.The study clearly indicated that TUIP is as effective as TURP for the treatment of small sized obstructive BPH. Alterations of sexual functions are similar in both the procedures. On the other hand, operating time, requirement of irrigation fluid and blood transfusion, postoperative catheterization period and hospital stay are significantly (P>0.001) less in TUIP group than that of TURP.In conclusion, we recommend TUIP for the treatment of LUTS caused by small size obstructing benign prostatic hyperplasia.   doi: 10.3329/taj.v19i2.3149 TAJ 2006; 19(2): 50-56

scholarly journals MODERN METHODS OF ENDOSCOPIC ENUCLEATION OF BENIGN PROSTATIC HYPERPLASIA AND PROSPECTS FOR THEIR MODIFICATION

2021 ◽  
pp. 20-29
Author(s):  
E. N. Bolgov ◽  
F. A. Sevryukov ◽  
V. V. Zhezdrin ◽  
R. N. Bobrovsky ◽  
M. A. Volodin
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Laser Energy ◽  
Low Frequency ◽  
Complete Removal ◽  
Infectious Complications ◽  
Prostatic Hyperplasia ◽  
Anatomical Landmarks ◽  
Surgical Methods ◽  
Endoscopic Enucleation

The disadvantage of bipolar and holmium enucleation in transurethral surgery of benign prostatic hyperplasia (BPH) is the frequent postoperative urination disorders. To increase the effectiveness of surgical treatment, a modification of the surgical technique is necessary.Objective: to compare the perioperative results of endosurgical treatment of large sized BPH using transurethral bipolar (TUEB), laser (HoLEP) and modified laser prostate enucleation (HoLEP-M) methods. Patients and methods: A randomized prospective study was conducted according to the results of surgical treatment of 1104 patients with BPH with a volume of 80 to 350 cm3, divided by methods of endoscopic enucleation of the prostate. A mod-ification of the HoLEP technique was to optimize access to the surgical site with the designation of new anatomical landmarks.Results: Comparison of surgical methods showed their equivalence in the volume of removed tissue, the low frequency of hemorrhagic and infectious complications, the dynamics of urological indicators in the delayed period. TUEB has the least parameters for the time of surgical intervention (98.2 ± 2.24 min.), the vol-ume of blood loss (65.5 ± 1.83 ml), the terms of postoperative catheterization of the bladder (2.0 ± 0.32 days), and the days of hospitalization (3.2 ± 0.40 days). The safety of laser methods is higher than TUEB, during which 3.1% of closed perforations of the prostatic capsule and bladder were observed (versus 0.8-1.5% with laser methods). Modification of the HoLEP technique allows reducing the frequency of late dysuric disorders by 2-3 times, urinary incontinence by 3.4-4 times, cicatricial complications by 1.7-2 times.Conclusion: Bipolar and laser methods of transurethral enucleation of the prostate of large sizes are comparable by criteria of complete removal of prostatic tissue, effectiveness and tolerability in patients with thrombohemorrhagic risk. In terms of the frequency of intraoperative injuries, the safety of laser methods is higher due to the reduced penetrating ability of laser energy. Modification of surgical access to the prostate preserves the prostatic urethra as much as possible and is a promising measure for the prevention of late obstructive and functional complications of transurethral interventions.

COMPARACIÓN DE LOS RESULTADOS CLÍNICOS EN PACIENTES CON HIPERPLASIA PROSTÁTICA BENIGNA CON TRATAMIENTO INICIAL FARMACOLÓGICO, NO FARMACOLÓGICO Y QUIRÚRGICO, ATENDIDOS EN EL HOSPITAL PABLO ARTURO SUÁREZ DE ENERO 2014 A DICIEMBRE 2016.

2020 ◽  
Vol 31 (1) ◽  
Author(s):  
Esteban Noroña Vásconez ◽  
Patricia Páez Vargas
Keyword(s):  
Surgical Treatment ◽  
Benign Prostatic Hyperplasia ◽  
Pharmacological Treatment ◽  
Clinical Signs ◽  
Clinical Results ◽  
Scientific Data ◽  
Prostatic Hyperplasia ◽  
Urinary Symptoms ◽  
Post Intervention ◽  
Significant Difference

Background: Currently there are few scientific data comparing the three therapeutic modalities of Benign Prostatic Hyperplasia to determine the best clinical outcome, considering that it is a pathology whose incidence increases as population life expectancy arise. Objective: To compare the clinical results between the initial pharmacological, non-pharmacological and surgical treatment, based on clinical signs of prostatism in patients with benign prostatic hyperplasia during the period between January 2014 and December 2016. Study Design: Retrospective Cohort Study. Methods: 399 patients were divided according to the modality of treatment received: non-pharmacological, pharmacological and surgical. The decrease of the symptoms was compared with the first post-treatment consultation by using a matrix of evaluation of urinary symptoms elaborated by the authors, based on SPSS International Score; this tool stratified the patients by the severity of the symptomatology. SPSS ® software was used. Results: Within the non-pharmacological treatment, there was a mean difference of 1.67 (95% CI 0.49 - 2.85, p <0.05); for the pharmacological it was 0.21 (95% CI 0.92 - 1.34, p = 0.713) and for the surgical was 8.23 (95% CI 7.19 - 9.27, p <0.05). Significant differences were found between the three groups during the pretreatment phase, after stratifying them according to the degree of severity. Post-intervention, the clinical results of each treatment were compared, finding that in patients with mild symptoms there were no significant differences (p = 0.087), not so for patients with moderate and severe symptoms where a statistically significant difference was found. Conclusion: In patients with urinary symptoms classified as moderate and severe within this sample, surgical treatment decreased urinary symptomatology in greater proportion compared to pharmacological and non-pharmacological treatment.

scholarly journals Actual aspects of the use of thulium laser as a promising method in the treatment of prostatic hyperplasia

2021 ◽  
pp. 579-584
Author(s):  
Arseniy A. Shiryaev ◽  
◽  
Alexander V. Govorov ◽  
Aleksandr O. Vasilyev ◽  
Aleksandr O. Vasilyev ◽  
...  
Keyword(s):  
Benign Prostatic Hyperplasia ◽  
Recovery Period ◽  
Massive Bleeding ◽  
Prostatic Hyperplasia ◽  
The Body ◽  
Urinary Flow ◽  
Male Population ◽  
Surgical Interventions ◽  
Minimally Invasive Surgical ◽  
Surgical Methods

Lower urinary tract symptoms caused by benign prostatic hyperplasia are the most widespread and frequent urological problem among men, affecting about a third of the male population of Russia over 50 years of age. Surgical intervention is the most effective method of treating benign prostatic hyperplasia, and about 75,000 surgical interventions are performed annually in Russia. Today, of all available surgical treatments, monopolar transurethral resection of the prostate (TURP), in which enlarged prostate tissue is resected with a monopolar electrode, has been the preferred surgical method since the 1970s. This method of therapy can significantly improve the maximum urinary flow rate (Qmax), reduce obstructive symptoms assessed on the basis of the international questionnaire on the severity (IPSS) and improve the quality of life of patients. However, monopolar TURP is a rather risky procedure due to the possibility of developing serious complications such as massive bleeding or TURP syndrome (water intoxication syndrome of the body). Consequently, practicing urologists all over the world are faced with the urgent task of developing minimally invasive surgical methods of treatment, the results of which would be at least similar to those after monopolar TURP, while with fewer intra- and postoperative complications, side effects and a shorter recovery period for the patient.

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