Transurethral anatomical enucleation of the prostate using a 1470-nm diode laser (DiLEP) versus transurethral resection of the prostate (TURP) for large-volume benign prostatic hyperplasia: a prospective randomized controlled trial.

We compared the effectiveness and complications of 980-nm diode laser vaporization and transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH). In total, 72 consecutive patients with BPH entered the study. All patients underwent general and urological evaluations. The primary outcome was improvement in the International Prostate Symptom Score (IPSS). The secondary outcomes were IPSS quality of life (QoL), maximum urinary flow rate (Qmax), residual volume, and complications. Patients were allocated randomly to the TURP and laser groups. The Ceralas HPD120, a diode laser system emitting at a wavelength of 980 nm, was used for photoselective vaporization of the prostate (PVP). TURP was performed with a monopolar 26 French resectoscope. Preoperative and operative parameters and surgical outcomes were compared. In total, 36 patients in each group underwent PVP and TURP. The mean age ± standard deviation was 63.1 ± 9.1 years and 64.7 ± 10.2 years in the PVP and TURP groups, respectively. There were no statistically significant differences in age, prostate size, prostate-specific antigen concentration, Qmax, preoperative IPSS, or preoperative Qmax between the two groups. The operation duration was also similar between the groups (P = .36). The catheterization time was 1.45 ± 0.75 and 2.63 ± 0.49 days in the PVP and TURP groups, respectively (P < .01). The PVP group had a shorter hospital stay than the TURP group. The 3-month postoperative Qmax increased to 9.90 ± 3.61 and 6.59 ± 6.06 mL/s from baseline in the TURP and PVP groups, respectively; there was no difference in the increases between the groups (P = .08). The IPSS and IPSS-QoL were significantly improved with the operation (P < .01), and this improvement was similar in both groups P = .3 and P = .8, respectively . The complication rate was also similar between the two groups. PVP with a diode laser is as safe and effective as TURP in the treatment of BPH, and the techniques have similar complication rates and functional results. PVP has the advantage of shorter hospitalization and catheter indwelling times and no need for discontinuation of anticoagulant therapy.

Benign prostatic hyperplasia (BPH) is highly prevalent in the aging male population. Transurethral resection of the prostate (TURP), the current gold standard treatment, demonstrates significant efficacy but is associated with complications and high retreatment rates. Extraperitoneal laparoscopic urethra-preserving prostatectomy has emerged as a promising minimally invasive surgical alternative. This study aimed to compare the efficacy and safety of modified extraperitoneal laparoscopic surgery with conventional TURP for BPH treatment. Ninety-two patients with BPH who underwent surgical treatment between May 2022 and July 2023 were included in this retrospective study and divided into two groups with 46 each: Transurethral resection of the prostate (TURP) group and extraperitoneal laparoscopic surgery (ELS) group. Preoperative International Prostate Symptom Score (IPSS), maximum urine flow rate (MFR), residual urine volume (RUV) and quality of life (QOL) scores were recorded and compared with those at the 3-month follow-up. Patient age, body mass index (BMI), prostate-specific antigen (PSA), prostate size and complications were also documented and compared between the groups. Ninety-two patients were included in this study (46 in each group). Baseline characteristics were comparable between the groups. At 3 months, both groups demonstrated significant improvements in IPSS, MFR, RUV and QOL scores (p < 0.001). Compared with the TURP group, the ELS group showed greater improvements in IPSS, MFR, RUV and QOL scores, with fewer postoperative complications (p < 0.001). Extraperitoneal laparoscopic prostatectomy using the modified urethra-preserving technique was beneficial for restoring urinary continence and improving patients' quality of life. This approach showed favourable perioperative outcomes and low complication rates. Further studies with large sample sizes and extended follow-up periods are required to confirm these findings and determine the long-term efficacy of this strategy.

Urodynamics after TURP and HoLEP in urodynamically obstructed patients: Are there any differences at 1 year of follow-up?

Background: Benign prostatic hyperplasia (BPH) is a common chronic progressive disease resulting in urinary obstruction in aging men. It comes to more and more patients with massive BPH with the aging of society and extension of life expectancy. Objective: The aim of the study was to compare the clinical efficacy, safety, and complications between transurethral bipolar plasmakinetic enucleation of the prostate (PKEP) and transurethral resection of the prostate (TURP) in the treatment of massive BPH. Design and Setting: Patients with BPH were divided into the PKEP group and the TURP group randomly. Intraoperative blood loss (BL), operation time (OT), resected tissue weight (RTW), gland resection ratio (GRR), postoperative indwelling ureter time (IUT), bladder fistula time (BFT) and hospital stay time (HST), preoperative and postoperative serum sodium concentration (SSC), hemoglobin concentration (HGB), prostate weight (PW), postvoid residual (PVR), maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life (QOL), International Index of Erectile Function (IIEF), and other complications were analyzed and compared respectively. Results: There was no statistical difference in preoperative IPSS, preoperative QOL score, preoperative PVR, preoperative Qmax, postoperative QOL score, postoperative PVR, postoperative Qmax, IPSS difference value (DV), Qmax DV, and PVR DV between the PKEP group and the TURP group (p > 0.05). OT, BL, IUT, BFT, HST, and postoperative IPSS in the PKEP group were significantly lower than that in the TURP group (p < 0.01). RTW and GRR in the PKEP group were significantly higher than that in the TURP group (p < 0.01). QOL DV in the PKEP group was higher than that in the TURP group (p < 0.05). There was statistical difference in SSC DV between the PKEP group and the TURP group (p < 0.05). There was significant statistical difference in postoperative PW, postoperative HGB, PW DV, and HGB DV between the PKEP group and the TURP group (p < 0.01). There was significant statistical difference in IPSS, QOL, PVR, and Qmax between postoperative value and preoperative value in both groups (p < 0.01). The incidence of transurethral resection syndrome, obturator nerve reflex, transient urinary incontinence, and retrograde ejaculation between the PKEP group and the TURP group has no statistical difference (p > 0.05). Capsule perforation, blood transfusion, secondary hemorrhage, bladder neck contracture, and urethral stricture in the PKEP group were lower than that in the TURP group (p < 0.05). Bladder spasm in the PKEP group was significantly lower than that in the TURP group (p < 0.01). There was no statistical difference in preoperative and postoperative IIEF-5, effective erectile frequency, telotism average tension, sustainable telotism average time, and sexual dissatisfaction between the PKEP group and the TURP group (p > 0.05). Conclusions: PKEP and TURP have similar clinical efficacy in the treatment of massive BPH. PKEP has advantages in shorter OT, less BL, more GRR, and fewer complications, but the long-term therapeutic effect of PKEP needs further follow-up.

Objective To compare the safety and efficacy of the two surgical approaches, 1 470 nm laser resection of the prostate-selective massive (LRP-SM) versus transurethral resection of the prostate (TURP), in the treatment of benign prostatic hyperplasia (BPH). Methods From February 2018 to February 2019, 98 cases of BPH were enrolled, 52 cases underwent LRP-SM, while 46 cases were treated by TURP. The operative time, hemoglobin, duration of postoperative bladder irrigation, indwelling catheterization time, hospital stay and the postoperative complications were recorded. The international prostate symptoms score (IPSS), quality of life (QOL), post-voiding residual urine (PVR), maximum urine flow rate (Qmax) were also compared. Results Patients in the LRP-SM group displayed shorter operative time [(42.2±16.3) min vs (58.4±18.2) min, P 0.05). 2 cases required blood transfusion in the TURP group after operation while none in the LRP-SM group. The incontinence presented in both groups (3 patients in the TURP group and 1 in the LRP-SM group), but all recovered within 1-3 months. Re-operations due to the urethral stricture and bladder neck contracture were needed in 1 case in the TURP group while none in the LRP-SM group. Etrograde ejaculation was reported in 16 cases of the TURP group and 4 cases in the LRP-SM group. Perioperative complications were fewer in the LRP-SM group (P<0.05). Conclusions LRP-SM is an excellent treatment for BPH as well as TURP. However, compared with TURP, LRP-SM has the advantages of less risk of bleeding, rapid recovery, and lower incidence of complications, and it is especially suitable for patients with advanced age, high risk and sexual function needed. Key words: BPH; TURP; 1 470 nm laser

BackgroundTransurethral resection of the prostate (TURP) was considered the golden standard to treat benign prostatic hyperplasia (BPH) for decades. However, TURP was associated with low efficiency to alleviate the lower urinary tract symptoms (LUTS) and a significantly higher risk of bladder neck contracture (BNC) for patients with small-volume BPH. Our study aims to compare the therapeutic effect of a transurethral split of the prostate (TUSP) with TURP for patients with small-volume BPH (<30 mL).MethodsIn this study, 101 small-volume BPH patients were randomly divided into two groups (TUSP and TURP group). The patient’s baseline characteristics and perioperative outcomes were recorded. The follow-up was done at six months, one year and two years after surgical treatment.ResultsNo significant differences were observed between the two groups for the baseline characteristics, including age, prostate volume, prostate-specific antigen (PSA) level, concurrent disease, post-void residual (PVR), maximum urinary flow rate (Qmax), international prostate symptoms score (IPSS), and quality of life (QoL) score. The operative time and hemoglobin decrease were significantly lower in the TUSP group compared to the TURP group. However, no significant differences were observed between both groups for catheterization time, postoperative hospital stay, and incidence of transurethral resection syndrome (TURS). However, of the late complications, the incidence of BNC in the TUSP group was significantly lower than the TURP group. No significant differences were found between both groups for other complications, including postoperative bleeding, micturition urgency, micturition frequency, micturition pain, urinary tract infection, recatheterization, transient incontinence, and continuous incontinence. Follow-up results showed that the IPSS of the TUSP group was significantly lower than the TURP group, while the Qmax of the TUSP group was significantly higher than the TURP group.ConclusionsThis study shows that TUSP may be an efficient and safe treatment for small-volume BPH (<30 mL) with a lower incidence of postoperative BNC and better longtime clinical outcomes than TURP. It suggested that TUSP could be an ideal treatment choice for small-volume BPH.

Transurethral resection of the prostate (TURP) is considered gold standard for surgical treatment of benign prostatic hyperplasia (BPH). In this study, we aimed to compare post-operative clinical outcomes and adverse effects between monopolar and bipolar TURPs. The study included 590 patients who underwent TURP by a single urologist (E.H.) between June 2006 and June 2014 with a diagnosis of BPH. Patients were divided into two groups as monopolar TURP (group 1, n = 300) and bipolar TURP (group 2, n = 290). Patients receiving oral anticoagulants or aspirin and those with prostate cancer diagnosis were not included in the study. Data regarding pre-operative age, International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post voiding residual urine volume (PVR), serum prostate specific antigen (PSA) levels and prostate volume (Vp) of the patients were gathered from medical records. Groups were compared in terms of catheterization, operation time, hemoglobin (Hb) decrease, and IPSS, Qmax, and PVR values at post-operative 12th month follow-up visit. From pre-operative to post-operative period, IPSS, Qmax and PVR showed significant improvements within both groups (P < .001). When groups were compared with each other, bipolar TURP group had significantly lesser catheterization time and hemoglobin decrease than monopolar TURP group, while no significant differences were detected regarding all other variables. Bipolar and monopolar TURPs are both effective and safe treatment modality for BPH. Bipolar TURP is superior to conventional monopolar TURP in terms of catheterization time and Hb decrease.

Objective To compare the clinical effect between retropubic extraperitoneal laparoscopic prostatectomy with prostatic urethra preservation and transurethral resection of the prostate (TURP) for giant benign prostatic hyperplasia (BPH).Methods The clinical data and follow-up of 128 cases of giant BPH were analyzed retrospectively.Seventy-two cases underwent TURP (TURP group) and 56 cases underwent retropubic extraperitoneal laparoscopic prostatectomy with prostatic urethra preservation ( laparoscopic group ).The operation time,blood loss,gland mass excision,bladder washing time,catheterization time,hospital stay,hospital cost,international prostate symptoms score (IPSS) and quality of life questionnaires (QOL),maximum flow rate (MFR),residual urine volume (RUV) were compared between two groups.Results The bladder washing time,catheterization time,hospital stay in laparoscopic group were less than those in TURP group[0 d vs.(2.8 ± 1.2) d,(2.3 ± 0.6) d vs.(5.2 ± 1.5) d,(4.2 ± 0.5) d vs.(7.5 ±0.5) d],gland mass excision in laparoscopic group was more than that in TURP group [(100.2 ±25.4) g vs.(85.6 ± 15.5) g],there were significant differences between two groups(P＜ 0.05).There was no significant difference in the operation time,blood loss,hospital cost between two groups (P ＞ 0.05).There were significant differences in IPSS,QOL,RUV and MRF before and after 3,6 months treatment for two groups [ laparoscopic group:(9.1 ± 3.4),(7.5 ± 2.5 ) scores vs.(27.5 ± 5.8) scores,( 1.8 ± 1.1 ),( 1.6 ± 0.8)scores vs. (5.5 t0.5) scores,(26.5 ± 11.5),(22.4 ± 12.6) ml vs. (145.0 ±48.0) ml,(17.6 ±8.4),(20.2 ± 5.4) ml/s vs.(8.3 ± 3.5) ml/s;TURP group:(9.2 ± 3.8),(7.8 ± 2.2) scores vs.(28.5 ± 5.4) scores,( 1.9 ± 1.2),( 1.7 ± 0.6) scores vs.(5.0 ± 0.5 ) scores,(28.5 ± 12.9),(23.0 ± 11.7) ml vs. ( 155.0 ± 47.0) ml,( 17.8 ± 9.2),( 19.8 ± 4.5 ) ml/s vs.(7.2 ± 3.2 ) ml/s ] (P ＜ 0.01 ),but there was no significant difference between two groups (P ＞ 0.05).Conclusions The clinical effect of two microtrauma surgery are good.Laparoscopic technique is a feasible treatment option for patients suffered from giant BPH for which has the benefit of a quicker recovery,shorter hospital stay,less complications,no bladder washing. Key words: Prostatic hyperplasia; Laparoscopies; Transurethral resection of prostate

Objective: To explore the clinical effect and safety of modified Chailing paste on improving postoperative lower urinary tract symptoms (LUTS) and bladder neck contracture in pa-tients with small-volume prostatic hyperplasia (SBPH) complicated with chronic prostatitis after transurethral resection of the prostate (TURP). Methods: A total of 145 patients with SBPH were enrolled in a randomized double-blind placebo-controlled study and randomly divided into three groups. Group A (49 patients) underwent simple TURP, Group B (48 patients) underwent TURP combined with postoperative Tamsulosin, and Group C (48 pa-tients) underwent TURP combined with modified Chailing paste. Tissue specimens from all patients were sent for pathological examination. Data were analyzed using SPSS22.0 statistical software. Results: The study followed up 141 patients. The detection rate of his-tological prostatitis (HP) was 92.91%. Significant improvements in residual urine volume (PVR), International Prostate Symptom Score (IPSS), quality of life (QOL) score, and max-imum urine flow rate (Qmax) were observed in all groups before and 3 months after surgery (P &lt; 0.01). Group C showed statistically significant improvement compared to Groups A and B (P &lt; 0.05). The incidence of bladder neck contracture 12 months post-operation was significantly lower in Group C compared to Groups A and B (P &lt; 0.05). Conclusion: Modified Chailing paste significantly improves postoperative LUTS symptoms and qual-ity of life and reduces the incidence of bladder neck contracture in patients with SBPH complicated with chronic prostatitis after TURP.

Society of Interventional Radiology Research Reporting Standards for Prostatic Artery Embolization

To compare long-term results of transurethral resection of the prostate (TURP), contact laser prostatectomy (CLP) and electrovaporization of the prostate (EVAP) in men with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Between 1996 and 2001, a prospective, randomized controlled trial was conducted in 150 men with LUTS suggestive of BPH, who had a prostate volume of 20-65 mL and a Schäfer's obstruction grade of > or =2. Outcome variables were the International Prostate Symptom Score (IPSS), Quality of Life (QoL) question, Symptom Problem Index (SPI), BPH Impact Index (BII), maximum urinary flow rate (Q(max)), prostate volume, prostate specific antigen (PSA) level, morbidity and mortality. In 2008 we carried out a long-term follow-up in these patients. Long-term values were compared with preoperative values for each treatment group (Wilcoxon signed-rank test), differences among groups were analysed (Kruskal-Wallis test) and actuarial failure-rates of the interventions were determined (Kaplan-Meier analysis). Although we could account for 91% of the initial participants in 2008, 66 (44%) patients (29 TURP, 20 CLP and 17 EVAP) were available for follow-up measurements after a mean (range) of 10.1(6.9-12.7) years Among the three treatment groups, there were no significant differences in IPSS, QoL, SPI, BII, Q(max), PSA level and prostate volume. The IPSS, QoL, SPI and BII were still improved (P < 0.05) from values before treatment for all treatments. Only in the TURP group were the long-term results of Q(max) still improved (P < 0.05). The mortality rate was comparable among the treatments. The 10-year actuarial failure rates (95% confidence interval) were 0.11 (0.03-0.20), 0.22 (0.10-0.35) and 0.23 (0.11-0.35) for TURP, CLP and EVAP, respectively. After a mean follow-up of 10.1 years, there were similar and durable improvements in IPSS, QoL, SPI and BII for patients with LUTS suggestive of BPH after TURP, CLP and EVAP. Between the treatment groups there were no statistically significant differences in Q(max), PSA levels and prostate volume at any time during the follow-up. However, only patients treated with TURP showed minimal durable improvements in Q(max). There was no statistically significant difference in success rate and mortality rate among the three treatments.

To assess the efficacy and safety of prostate artery embolization (PAE) for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and to conduct an indirect comparison of PAE with transurethral resection of the prostate (TURP). As a joint initiative between the British Society of Interventional Radiologists, the British Association of Urological Surgeons and the National Institute for Health and Care Excellence, we conducted the UK Register of Prostate Embolization (UK-ROPE) study, which recruited 305 patients across 17 UK urological/interventional radiology centres, 216 of whom underwent PAE and 89 of whom underwent TURP. The primary outcomes were International Prostate Symptom Score (IPSS) improvement in the PAE group at 12months post-procedure, and complication data post-PAE. We also aimed to compare IPSS score improvements between the PAE and TURP groups, using non-inferiority analysis on propensity-score-matched patient pairs. The clinical results and urological measurements were performed at clinical sites. IPSS and other questionnaire-based results were mailed by patients directly to the trial unit managing the study. All data were uploaded centrally to the UK-ROPE study database. The results showed that PAE was clinically effective, producing a median 10-point IPSS improvement from baseline at 12months post-procedure. PAE did not appear to be as effective as TURP, which produced a median 15-point IPSS score improvement at 12months post-procedure. These findings are further supported by the propensity score analysis, in which we formed 65 closely matched pairs of patients who underwent PAE and patients who underwent TURP. In terms of IPSS and quality-of-life (QoL) improvement, there was no evidence of PAE being non-inferior to TURP. Patients in the PAE group had a statistically significant improvement in maximum urinary flow rate and prostate volume reduction at 12months post-procedure. PAE had a reoperation rate of 5% before 12months and 15% after 12months (20% total rate), and a low complication rate. Of 216 patients, one had sepsis, one required a blood transfusion, four had local arterial dissection and four had a groin haematoma. Two patients had non-target embolization that presented as self-limiting penile ulcers. Additional patient-reported outcomes, pain levels and return to normal activities were very encouraging for PAE. Seventy-one percent of PAE cases were performed as outpatient or day cases. In contrast, 80% of TURP cases required at least 1 night of hospital stay, and the majority required 2 nights. Our results indicate that PAE provides a clinically and statistically significant improvement in symptoms and QoL, although some of these improvements were greater in the TURP arm. The safety profile and quicker return to normal activities may be seen as highly beneficial by patients considering PAE as an alternative treatment to TURP, with the concomitant advantages of reduced length of hospital stay and need for admission after PAE. PAE is an advanced embolization technique demanding a high level of expertise, and should be performed by experienced interventional radiologists who have been trained and proctored appropriately. The use of cone-beam computed tomography is encouraged to improve operator confidence and minimize non-target embolizations. The place of PAE in the care pathway is between that of drugs and surgery, allowing the clinician to tailor treatment to individual patients' symptoms, requirements and anatomical variation.

Objectives To investagate the efficacy and safety of Combination of Transurethral enucleation of the prostate (TUEP) and Transurethral resection of prostate (TURP) in the treatment of patients with Intravesical and giant benign prostatic hyperplasia (BPH).Methods Data of 58 cases of BPH with Intravesical and big volume,to whom Combination of TUEP and TURP were performed,were retrospectively studied.Parameters including intraoperative blood loss,operating time,complications of intraoperative hyponatremia,postoperative were invesgated to evaluated the clinical safety.Resected tissue weighed,catheterization time,the consumption of TURP ring and maximum urinary flow rates(Qmax),residual urine volume (RUV),International Prostate Symptom Score (IPSS),quality of life score (QOL) were compared to evaluated the clinical efficacy.Results The age of patients was 80.5 ±9.2(range from 72 to 94)years old.The prostatic gland volume was 125.4 ±39.7 (range from 80mL to 160mL).Intravesical prostatic protrusion 3.4 ± 1.6 (range from 1.9cm to 4.7 c m),All the cases were treated by treatment of Combination of TURP,and then TUEP.The mean operative time was 69.8 ± 14.4 (range from 40minutes to 95minutes) and the estimated blood loss was 115.6 ± 35.2 (range from 20mL to 180mL).No patient required conversion to open surgery.Blood transfusion was not necessary in this group of patients.Bladder irrigation was (2.8 ±1.2) d,and the average Foley catheter duration was 5.2 ± 1.5d (range from 2 days to 7 days).Qmax,RUV,IPSS and QOL were significantly improved 3 months later (P ＜ 0.01),No urinary incontinence,bled postoperation,and urethremphraxis was reported.Conclusions Treatment of Combination of transurethral resection and enucleation of the prostate for Intravesical and giant benign prostatic hyperplasia is feasible and reproducible for its less blood loss,less operating time,less incidence of intraoperative hyponatremia,less consumption of TURP ring,shorter hospital stay and early return to normal activity,more resected tissue weighed,rapid recovery and assured clinical effect. Key words: Prostatic Hyperplasia; Electrosurgery

Long-term outcome of men with lower urinary tract symptoms recruited to the CLasP randomised trial comparing transurethral resection of the prostate, conservative management and laser therapy

PurposeTransurethral resection of the prostate (TURP) is still considered the gold standard in the treatment of benign prostatic hyperplasia (BPH). However, open prostatectomy is indicated for prostate glands over 75 ml. There have been few reports concerning the use of TURP for large prostate glands over 100 ml. Herein we compared the effectiveness of monopolar TURP, bipolar TURP, and open prostatectomy in prostate glands larger than 100 ml.Materials and MethodsWe reviewed the data of 48 patients with prostate glands larger than 100 ml. A total of 19, 17, and 12 patients underwent monopolar TURP (group A), bipolar TURP (group B), or open prostatectomy (group C), respectively. Preoperative International Prostate Symptom Score (IPSS), maximal flow rate (Qmax), prostate volume, resected tissue volume, resection velocity, and operative time were documented. Postoperative hemoglobin, serum sodium change, hospital stay, and postoperative 6-month IPSS and Qmax were evaluated.ResultsThe prostate volumes did not differ significantly among the three groups. Operative time was similar in the two TURP groups, but open prostatectomy required a longer operative time. There was no significant difference in the resected prostate tissue or resection velocity between the two TURP groups. There was a marked decrease in postoperative serum sodium in the monopolar group compared with the other two groups. Among the groups, bipolar TURP required a shorter hospitalization. Postoperative IPSS, quality of life (QoL), and Qmax improved significantly in all groups.ConclusionsEven for large prostate glands, the results of this study suggest that bipolar TURP is an effective and safe operation owing to the significant improvements in voiding symptoms, shorter hospitalization, and fewer complications such as transurethral resection syndrome.