Surgical treatment of benign prostatic hyperplasia: modern methods and potentials

Abstract

Background. Benign prostatic hyperplasia (BPH) is one of the commonest diseases in male population. Surgical treatment is recommended in cases if a patient doesn't want to begin or continue his medication or lower urinary tract symptoms (LUTS) progression or complicated course of the disease. Over the past two decades there has been a significant expansion of the range of types of surgical treatment. Objectives. Conduct a comparative analysis of endovideosurgical treatment of BPH. Materials and methods . In the course of work on this issue, the following databases were analyzed: PubMed, ScienceDirect, Cohrane Library, UpToDate, eLibrary with a search range in the last 30 years, next key words were used: «benign prostatic hyperplasia», «urethral stricture», «bladder neck contracture», «TuRP», «HoLEP», «ThuLEP», «GreenLight laser». Search range: from 1989 to 2019. Results. Based on the results of numerous studies, thulium, holmium and GreenLight lasers show the best results. Laser surgery is longer than the transurethral resection of the prostate (TURP), however, the rates of hospitalization and catheterization are more significant for patients. Efficiency and safety are also two of the most important criteria, and in this respect, thulium and holmium lasers perform well. Thulium laser provides an excellent result of vaporization of the prostate tissue and reliable hemostasis without causing significant thermal injury to the surrounding tissues. Holmium laser shows the lowest rates of re-catheterization, urinary retention, inflammatory and infectious complications, stress urinary incontinence and retrograde ejaculation, but there is a chance of damaging the prostate gland capsule. GreenLight laser, due to the specificity of its wavelength, has excellent hemostasis but this entails greater thermal damage to the surrounding tissues. Conclusion. Of course, all the considered techniques are safe and effective. But due to the characteristics of each of the methods, a competent selection of the intervention method for each patient is necessary to improve the effect of surgical treatment.