Treatment Of Benign Prostatic Hyperplasia Research Articles

Holmium laser enucleation for large prostate hyperplasia: assessment of functional outcomes and postoperative complications

Introduction. To date, there has been insufficient research into the prostate volume as a factor that may influence the effectiveness and safety of surgical treatments. With the advent of relatively new laser techniques, it is important to take a closer look at this parameter, especially considering the success of these techniques in the treatment of benign prostatic hyperplasia (BPH) of various volumes.Objective. To assess the functional outcomes and postoperative complications of holmium laser enucleation of the prostate (HoLEP) depending on its volume.Materials & Methods. We performed a prospective study of HoLEP on 252 patients. Patients were divided into two groups according to their prostate volume: Group I included 206 patients (81%) with a prostate volume of < 100 mL, and Group II included 46 patients (19%) with a prostate volume ≥ 100 mL.Results. The prostate volume was the most significant prognostic factor regarding duration of surgery. This indicator significantly differed between the two groups. Group I had an average surgery time of 67.1 ± 26.7 minutes, while Group II had a time of 98.1 ± 24.2 minutes (p < 0.05). There were no significant differences in the number of complications between the groups — 36 cases (17.5%) in Group I and 12 cases (26%) in Group II, as well as functional results of urination between the groups. In the early postoperative period, the Q max in Group I was 17.4 ± 9.1 ml/s, in Group II — 18.2 ± 10.9 ml/s (p > 0.05), PVR — 52 ± 39.4 and 56 ± 31.8 ml (p > 0.05), respectively. After 3 months of observation, there were also no differences in the studied parameters: IPSS — 5.7 ± 4.1 vs 6.2 ± 4.9 points; QoL — 1.0 ± 0.9 vs 1.1 ± 0.9 points; Q max — 18.9 ± 6.7 vs 20.3 ± 11.5 ml/s; PVR — 53.5 ± 33.1 vs 54.9 ± 30.6 ml (p > 0.05).Conclusion. HoLEP is an effective and safe method of treating patients with different volumes of BPH. However, the duration of the procedure is an important factor that influences the surgery outcome, as it correlates with the prostate volume.

Antibiotic resistance of microorganisms isolated from the urine of patients before surgical treatment for benign prostatic hyperplasia: results from a 7-year single-center study

Introduction. The tendency of microorganisms to develop resistance mechanisms is a widely discussed and significant problem worldwide. Studying regional differences in the qualitative characteristics of microorganisms provides valuable information for empirically preventing and treating infectious complications, as well as providing an enhanced understanding of the variability in microbial community properties within the clinical context of diseases and patients' comorbidity status.Objective. To assess the antibiotic resistance of microorganisms isolated in high titers from the urine samples of patients with benign prostate hyperplasia (BPH) prior to surgery.Materials & Methods. This single-center, retrospective study conducted from March 2016 to February 2023 included 59 suprapubic-draining BPH-patients (Group I), 46 drainage-free BPH-patients with leukocyturia (Group II), and 44 drainage-free BPH-patients and no leukocyturia (Group III). Inclusion criteria: indications for BPH surgery, no history of sexually transmitted diseases, no symptoms of urinary tract infection, and no prostate cancer. The patient's voluntary informed consents to participate were also obtained.Results. The rates of resistance to ciprofloxacin in patients of Group I were statistically significantly higher compared to Group II (85.7% vs 55.6%, p = 0.002). Resistance of gram-negative microorganisms to meropenem and imipenem was higher in Group III compared to Group I (31.1% vs 13.7%, p = 0.006 for meropenem and 44.5% vs 9.8%, p = 0.001 for imipenem, respectively). Resistance of Gram-positive microorganisms to ampicillin in Groups I to III was 13.6%,6.3% and 20.0%, respectively with no significant difference between groups (p > 0.05). However, there was extremely high resistance among verified Gram-positive organisms to all the drugs in the fluoroquinolone class (ciprofloxacin, norfloxacin, levofloxacin) ranged from 63.6% to 80.0%.Conclusion. The present study demonstrates that the isolation frequency of antibiotic-resistant microorganisms from the urine sample of drainage-free BPH-patients or no clinical and laboratory signs of inflammation in the urinary tract is high. The presence of antibiotic resistance provides risks for developing difficult-to-control infectious complications. Currently, assessment of urine-derived microbial antibiotic resistance should be considered in every BPH-patient with indications for surgical management of bladder outlet obstruction, regardless of the presence of risk factors.

Effect of benign prostatic hyperplasia surgery on ejaculatory function

Introduction. There are a wide range of techniques available for the removal of hyperplastic prostate tissue. However, the choice of method rarely considers its effect on ejaculatory function.Objectives. To evaluate the effect of surgery for benign prostatic hyperplasia (BPH) by endovideosurgical posterior adenomectomy (EVS AE) and transurethral electroenucleation of the prostate (TUEB) on copulatory function and its ejaculatory component.Materials & methods. Sixty sexually active patients aged 58 to 78 years with indications for surgical treatment of BPH were included in the study. The patients were randomized into two equal groups. The first group (30 patients) underwent EVS AE by standard technique without preservation of the prostatic urethra. The second group (30 patients) underwent TUEB. Before treatment, standard questionnaires used in urologic practice were completed: IIEF-5, IPSS-QOL, and the scale of quantitative assessment of male copulatory function (scale “MCF”). The block of questions specifically characterizing the ejaculatory component and the "Male Sexual Health Questionnaire", namely the section " Ejaculatory function domain", were analyzed separately. The assessment was conducted before treatment and at the 12th week following surgery. No significant differences were found between the groups on any of the questionnaires prior to surgery.Results. Three months following surgery, there was a significant improvement in the IPSS-QOL scores for the EVS AE group, by 24 points and 4.3, respectively, and for the TUEB group, 25.6 points and 4.3 (both p < 0.0001). No change was observed in the IIEF-5 questionnaire (p > 0.05). A slight reduction in scores was noted on the MCF scale for the TUEB group (by 2.9 points, p < 0.05), indicating that the general state of erectile function remained unchanged. However, reductions were seen in the "MCF — Ejaculatory Component" and "Male Sexual Health Questionnaire — Ejaculatory function domain" scales for the TUEB group, with ballpark scores decreasing by 3.2 and 6.8 points, respectively (both p = 0.0326 and p = 0.0254), indicating a worsening in ejaculatory function following TUEB treatment.Conclusion. When selecting a specific surgical approach for BPH management, consideration should be given to the patient's tolerance for the degree of invasiveness of the procedure while preserving ejaculatory function, and adherence to a treatment strategy that aligns with the patient's individual preferences and expectations.

Prostate Artery Embolization as Minimally Invasive Treatment for Benign Prostatic Hyperplasia: An Updated Systematic Review.

Background/Objectives: Benign prostatic hyperplasia (BPH) has a significant impact on the quality of life of symptomatic patients. In patients manifesting lower urinary tract symptoms (LUTS), prostatic arterial embolization (PAE) has become a topic of interest in recent years. The purpose of this systematic review is to analyze and review techniques and clinical outcomes of patients who underwent endovascular treatment of BPH, with a special focus on the comparison of surgical and endovascular procedures. Methods: Through the major scientific databases, 1225 articles were selected from the initial research utilizing specific keywords and medical subject headings. Based on the inclusion and exclusion criteria established for selecting relevant studies for our purposes, the systematic analysis of the literature was conducted on a total of seven articles. Results: We collected data on 718 male patients (408 patients underwent PAE and 310 received TURP). The technical success rate varied from 86% to 100% for TAE and was 100% for TURP. During a 12-month follow-up period, both PAE and TURP were comparable on the reduction in IPSS and QoL questionnaire, while TURP showed significant improvements in Qmax and in the reduction in prostate volume. Length and cost of hospitalization were lower for PAE. Complication and adverse events rates were higher in the TURP group rather than in the PAE group (60.6% vs. 35.5%). Conclusions: Prostatic artery embolization represents an emerging minimally invasive procedure for BPH. According to previously released clinical studies, quality-of-life and urological symptom scores of the PAE group were comparable to those of the TURP group. Our research strengthens the evidence supporting the effectiveness and safety of PAE as a therapy for LUTS related to BPH.

A meta-analysis comparing treatment of benign prostatic hyperplasia with holmium laser enucleation and photoselective greenlight vaporization

Abstract Background We compared the safety and efficacy of treating benign prostatic hyperplasia with photoselective greenlight vaporization (PVP) versus holmium laser enucleation of the prostate (HoLEP). Methods Databases (PubMed, Embase, Cochrane Library, Chinese CBM, and CNKI) were searched for eligible studies evaluating HoLEP or PVP outcomes, published until May 2022. We analyzed the incidence of relative complications and postoperative outcomes, including the international prostate symptom score, maximum flow rate (Qmax), postvoid residual urine volume, quality of life index, and prostate-specific antigen levels. Results Eleven studies involving 4763 patients were included in this meta-analysis. The significant differences in postoperative Qmax at 1 month (mean difference [MD], 3.31, 95% confidence interval [CI], 0.45–6.16, p = 0.02, I 2 = 92%), 3 months (MD, 2.78, 95% CI, 0.53 to 5.02, p = 0.02, I 2 = 89%), 6 months (MD, 2.13, 95% CI, 1.11 to 3.15, p < 0.0001, I 2 = 87%), and 12 months (MD, 3.98, 95% CI, 2.06 to 5.89, p < 0.0001, I 2 = 58%) further confirmed unique advantage of HoLEP over PVP. We used forest plots to determine significant differences in the severe complication rates among patients in the PVP and HoLEP groups (odds ratio, 0.05, 95% CI, 0.01 to 0.28, p = 0.0005). Conclusions Holmium laser enucleation of the prostate and PVP showed comparable international prostate symptom scores, quality of life index, postvoid residual urine volumes, prostate-specific antigen levels, perioperative factors, and total complication rates. Compared with PVP, HoLEP had a greater Qmax 1 year postoperatively, decreased energy expenditure, and fewer high-grade complications. These results need to be verified in long-term follow-up studies with well-structured randomized controlled trials.

Case-based presentation of the S2e guideline on the diagnosis and treatment of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the most common disease of the lower urinary tract in men. The prevalence increases continuously with increasing age and achronic progressive course is to be expected. In order to reduce the morbidity of affected patients and to improve their quality of life, the expert panel Benign Prostatic Hyperplasia (BPH) of the German Society of Urology (DGU) has written anew version of the evidence-based "S2e guideline on the diagnosis and treatment of BPH". Using acurrent patient case, the contents of the new S2e guideline are illustrated, from diagnosis to the decision-making process for asuitable treatment choice. The case presented here shows the possible complexity and difficulty that can arise in the diagnosis of BPH, the need for further diagnostic steps and the finding of asuitable therapy in order to fulfill the patient's wishes, if possible.

Systematic review and network meta-analysis of re-intervention rates of new surgical interventions for benign prostatic hyperplasia.

To assess the re-intervention rates of new surgical benign prostatic hyperplasia (BPH) interventions, as the clinical durability of new surgical interventions for BPH is not widely known. A critical review of new surgical BPH therapies namely 'UroLift®', 'Aquablation', 'Rezum', 'prostatic artery embolisation (PAE)' and 'temporary implantable nitinol device (iTIND)' was performed on PubMed, the Cochrane Library, and Embase databases between May 2010 and December 2022 according to the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement. All relevant articles were reviewed, and the risk of bias was evaluated using the Cochrane risk assessment tool and Newcastle-Ottawa Scale. Of the 32 studies included, there were 10 randomised controlled trials and 22 prospective observational cohorts. A total of 2400 participants were studied with a median patient age of 66 years, a median prostate volume of 51.9 mL, and a median International Prostate Symptom Score of 22. The lowest re-intervention rate at 12 months was for Aquablation at 0.01%, followed by Rezum at 0.02%, iTIND at 0.03%, and PAE at 0.05%. Network meta-analysis (NMA) showed that the best-ranked treatment at 12 months was transurethral resection of the prostate (TURP), followed by Aquablation, iTIND, Rezum, and UroLift. Re-intervention rates with these new BPH interventions are comparable, although some interventions reported better outcomes than TURP in the shorter term. While this systematic review and NMA showed that the re-intervention rate with these new surgical BPH interventions appears to be comparable to TURP in the short term, further studies are required to directly compare these various BPH procedures.

Antegrade ejaculation preservation in surgical treatment for benign prostatic hyperplasia: quest for balance between voiding and sexual function.

Surgical treatment of benign prostatic hyperplasia (BPH) carries a significant risk of ejaculation dysfunction. Preservation of antegrade ejaculation while providing effective, well tolerated, and durable treatment of BPH is a paramount component of physical and sexual well being for significant number of men. We reviewed available literature with an aim of providing status on antegrade ejaculation preserving BPH surgical therapies. Minimally invasive surgical therapies for BPH have been developed over the last decade, with significant marketing emphasis on their potential for preservation of antegrade ejaculation. However, the question about durability of relief of bladder outlet obstruction remains. Parallel to this technological development, the understanding of anatomical structures involved in ejaculation have resulted in technical modifications of well established surgical treatments modalities like transurethral resection of prostate, endoscopic enucleation of prostate and simple prostatectomy, thereby providing safe and durable relief of bladder outlet obstruction secondary to BPH with a satisfactory preservation of antegrade ejaculation. Preservation of antegrade ejaculation is an important goal for significant number of men needing BPH surgery. Novel minimally invasive surgical technologies have been developed for this purpose; but understanding of the anatomical structures essential for antegrade ejaculation have allowed technical modification of existing surgical techniques with excellent preservation of antegrade ejaculation.

Advances in HoLEP technology and technique – Current state of play

Background: Until recently, Holmium laser enucleation of the prostate (HoLEP) utilisation has been limited despite its perceived benefits over alternative surgical and minimally invasive benign prostatic hyperplasia (BPH) treatments. Objective: The purpose of this review is to highlight our experience with recent advances in laser and morcellator technologies that have made it easier for urologists to consistently offer HoLEP as a safe, efficient, and effective in an ambulatory (day surgery) setting. Methods: Our narrative review focused on contemporary studies published within the last five years. Conclusions: Technological advances coupled with increasing availability of training opportunities has and will continue to improve patients’ accessibility to the gold standard in BPH surgical treatment. Furthermore, we will describe refinements in laser enucleation techniques that have improved procedural efficiencies, rates of temporary post-operative urinary incontinence, and preservation of sexual function. The effects of technical modifications on functional and durability outcomes are to be seen in further prospective studies. Level of Evidence: Level 7 (Expert Opinion)

An analysis of benign prostatic hyperplasia surgical treatment reimbursement trends across Canada Examining provincial changes over the recent decade with comparison to cost of living changes.

A variety of procedures for the endoscopic surgical treatment of symptomatic benign prostatic hyperplasia (BPH) refractory to medical therapy have existed for decades. The present study examined trends in surgeon compensation for these treatments within Canada. The physician fee schedule for BPH surgery across 10 Canadian provinces for the years 2010 and 2023 were obtained. A descriptive study examined first the provincial reimbursement for transurethral resection of prostate (TURP) and laser ablative/enucleation surgery; second, the difference in TURP reimbursement between 2010 and 2023; and third, the annual change in TURP reimbursement juxtaposed with the annual change in the provincial Consumer Price Index (CPI) and annual salary for the working population aged 35-44. Seven of 10 Canadian provinces reimburse laser BPH surgery equally to TURP. The average provincial TURP reimbursement is $545, ranging from $451 in Ontario to $688 in Saskatchewan. Since 2010, TURP reimbursement has varied by province from a 0% net change in Ontario to an increase of 21% in Nova Scotia. Reimbursement for TURP has increased at a slower pace than the local CPI, and for half of the provinces at a slower pace than the annual salary for people aged 35-44. The compensation model for endoscopic BPH surgery does not have a unified structure in Canada that is consistent across provinces, nor does it keep up with inflation, possibly impacting future recruitment, increasing geographic disparities, and most importantly, limiting the adoption of new BPH therapies.

Endovascular treatment for benign prostate hyperplasia by embolisation

Endovascular treatment for benign prostate hyperplasia by embolisation

Benign Prostatic Hyperplasia Surgery: A Snapshot of Trends, Costs, and Surgical Retreatment Rates in the USA

BackgroundAn increasing number of novel surgical treatments (NSTs) for benign prostatic hyperplasia (BPH) have been proposed over time to achieve similar functional outcomes to, but better perioperative and sexual outcomes than traditional procedures. ObjectiveTo assess the trends in the utilization and costs of BPH surgical procedures over the past decade, and to analyze the need for surgical retreatment after each procedure. Design, setting, and participantsA retrospective observational population-based analysis was conducted using the PearlDiver Mariner (PearlDiver Technologies, Colorado Springs, CO, USA) database, including all-payer nationally available claims records collected from 2011 to 2022. Outcome measurements and statistical analysisThe number and type of BPH surgical procedures per year, costs associated with each BPH surgical treatment, incidence of BPH surgical retreatment rate, and time to BPH surgical retreatment were assessed. Negative binomial regression and Cochran-Armitage test were used for the temporal trend analysis. A multivariable logistic regression analysis evaluated the predictors of BPH surgical retreatment. Results and limitationsIn the study period, 274 808 patients received surgical treatment for BPH. The most common procedure was transurethral resection of the prostate (TURP; 71.7%). The overall utilization of BPH surgical treatment increased over the study period. Traditional surgery remained most performed for the entire period (87.8%), but a statistically significantly rising trend of NSTs was recorded. The mean reimbursements paid per procedure was 1.43 times higher (p < 0.001) for NSTs than for traditional procedures. The surgical retreatment rate was 9.4%. The mean time to surgical retreatment was 25.3 mo, with 85.5% of cases re-treated within 5 yr. At the multivariable analysis, transurethral incision of the prostate, photoselective vaporization of the prostate, prostatic urethral lift, convective water vapor energy, and prostatic artery embolization had a significantly greater likelihood of surgical retreatment than TURP. Holmium/thulium laser enucleation of the prostate (HoLEP/ThuLEP), open simple prostatectomy (SP), and laparoscopic/robot-assisted SP were associated with a lower probability of resurgery than TURP, but a similar probability between these procedures. Retrospective design and a lack of relevant clinical data were the main limitations. ConclusionsOver the past decade, there has been a progressive increase in the adoption of NSTs. The rate of surgical retreatment appears <10%, with patients undergoing SP and HoLEP/ThuLEP experiencing a statistically significantly lower probability of surgical retreatment. Patient summaryWe investigated the trends, costs, and surgical retreatments of benign prostatic hyperplasia surgery. Transurethral resection of the prostate remains the most common procedure. Novel surgical treatments are associated with an upward trend, despite appearing more expensive overall. Retreatment is necessary in <10% of patients and generally within 5 yr.

Use of 5-alpha reductase inhibitors and risk of gastrointestinal cancers in men with benign prostatic hyperplasia: A population-based cohort study.

Pre-clinical evidence suggests that 5-alpha reductase inhibitors (5ARi's), prescribed in the treatment of benign prostatic hyperplasia, reduce colorectal and gastro-oesophageal cancer incidence via action on the male hormonal pathway. However, few studies to date have investigated this association at the population level. Our study aimed to investigate the risk of colorectal and gastro-oesophageal cancers with the use of 5ARi's. We conducted a retrospective cohort study of new users of 5ARi's and alpha-blockers among patients with benign prostatic hyperplasia in the UK Clinical Practice Research Datalink. Patients were followed until a first ever diagnosis of colorectal or gastro-oesophageal cancer, death from any cause or end of registration with the general practice or 31st of December 2017. Cox proportional hazards models with inverse probability of treatment weights were used to calculate weighted hazard ratios (HR) and 95% confidence intervals (CIs) of incident colorectal cancer or gastro-oesophageal cancer associated with the use of 5ARi's compared to alpha-blockers. During a mean follow-up of 6.6 years, we found no association between the use of 5ARi's and colorectal (HR: 1.13, 95% CI 0.91-1.41) or gastro-oesophageal (HR 1.14, 95% CI 0.76-1.63) cancer risk compared to alpha-blockers. Sensitivity analysis showed largely consistent results when varying lag periods, using multiple imputations, and accounting for competing risk of death. Our study found no association between the use of 5ARi's and risk of colorectal or gastro-oesophageal cancer in men with benign prostatic hyperplasia.

Are adverse events during surgery for benign prostatic hyperplasia device related? A review of the MAUDE database.

The Manufacturer and User Facility Device Experience database contains anonymous, voluntary medical device reports. A review of device-related adverse events associated with Benign Prostatic Hyperplasia surgeries was completed. The objective was to evaluate the occurrence and contributing factors to clinically significant complications in a cohort of patients electing to undergo surgical intervention for Benign Prostatic Hyperplasia. The Manufacturer and User Facility Device Experience database was queried for "Aquablation, Greenlight Laser, Holmium Laser, Morcellator, Water Vapor Thermal Therapy, Loop Resection, and Prostatic Urethral Lift" from 2018 through 2021. A complication classification system (Level I-IV) based on the Clavien-Dindo system was used to categorize events. These events were then correlated with procedural technology malfunctions and classified as "device related" and "non-device related." Chi squared analysis was performed to identify associations between procedural technology and complication classification distribution. A total of 873 adverse events were identified. The adverse events were classified into level I (minimal harm) versus levels II-IV (clinically significant). Aquablation (p < 0.017) and Water Vapor Thermal Therapy (p < 0.012) were associated with a higher proportion of reports with Level II-IV complications compared with other procedure types. Level II-IV complications were not associated with a reported device related malfunction. Aquablation and water vapor thermal therapy demonstrated noteworthy clinically significant complications which were not driven by device-related malfunctions.

Elucidation of active components and target mechanism in Jinqiancao granules for the treatment of prostatitis and benign prostatic hyperplasia

Ethnopharmacological relevanceProstatitis and benign prostatic hyperplasia (BPH) are inflammations of the prostate gland, which surrounds the urethra in males. Jinqiancao granules are a traditional Chinese medicine used to treat kidney stones and this medicine consists of four herbs: Desmodium styracifolium (Osbeck) Merr., Pyrrosia calvata (Baker) Ching, Plantago asiatica L. and stigma of Zea mays L. Aim of the studyWe hypothesized that Jinqiancao granules could be a potential therapy for prostatitis and BPH, and this work aimed to elucidate active compounds in Jinqiancao granules and their target mechanisms for the potential treatment of the two diseases. Materials and methodsJinqiancao granules were commercially available and purchased. Database-driven data mining and networking were utilized to establish a general correlation between Jinqiancao granules and the two diseases above. Ultra-performance liquid chromatography-mass spectrometry was used for compound separation and characterization. The characterized compounds were evaluated on four G-protein coupled receptors (GPCRs: GPR35, muscarinic acetylcholine receptor M3, alpha-1A adrenergic receptor α1A and cannabinoid receptor CB2). A dynamic mass redistribution technique was applied to evaluate compounds on four GPCRs. Nitric acid (NO) inhibition was tested on the macrophage cell line RAW264.7. Molecular docking was conducted on GPR35-active compounds and GPR35 crystal structure. Statistical analysis using GEO datasets was conducted. ResultsSeventy compounds were isolated and twelve showed GPCR activity. Three compounds showed potent GPR35 agonistic activity (EC50 < 10 μM) and the GPR35 agonism action of PAL-21 (Scutellarein) was reported for the first time. Docking results revealed that the GPR35-targeting compounds interacted at the key residues for the agonist-initiated activation of GPR35. Five compounds showed weak antagonistic activity on M3, which was confirmed to be a disease target by statistical analysis. Seventeen compounds showed NO inhibitory activity. Several compounds showed multi-target properties. An experiment-based network reflected a pharmacological relationship between Jinqiancao granules and the two diseases. ConclusionsThis study identified active compounds in Jinqiancao granules that have synergistic mechanisms, contributing to anti-inflammatory effects. The findings provide scientific evidence for the potential use of Jinqiancao granules as a treatment for prostatitis and BPH.

Pulse modulation in En-Bloc HoLEP: does it really matter? A propensity score matched analysis

IntroductionHolmium laser enucleation of the prostate (HoLEP) is an established option in the surgical treatment of benign prostatic hyperplasia. Pulse modulation, such as MOSES® technology, has recently been introduced and may offer potential advantages in HoLEP.MethodsPerioperative data from 117 patients who underwent MOSES® laser enucleation of the prostate (MoLEP) were collected. Propensity score matching using prostate volume, age, body mass index (BMI), and anticoagulant intake was performed using a database of 237 patients treated with HoLEP. In total, 234 patients were included in the analysis.ResultsProstate volume (104 vs. 102 ml), age (70 vs. 71 years), BMI (27 vs. 27), and anticoagulant intake (34 vs. 35%) did not differ significantly between the groups. There were no significant differences in operation time (61.5 vs. 58.1 min, p = 0.42), enucleation efficiency (2.5 vs. 2.6 g/min, p = 0.74), hemostasis time (7.8 vs. 8 min, p = 0.75) and hemoglobin drop (0.9 vs. 0.7 mg/dl, p = 0.48). The complication rates were low in both groups (16.2% for HoLEP and 17.1% for MoLEP). No differences were noted in the Clavien-Dindo Classification (p = 0.63) and the Comprehensive Complication Index (p = 0.24). The rate of complications > CDC IIIa was 0.9% for HoLEP (endoscopic coagulation) and 1.7% for MoLEP (2 cases of endoscopic coagulation). No transfusions were administered.ConclusionOverall, the enucleation efficiency was high in both groups and the procedure time was short. HoLEP is an efficient and safe treatment option in experienced hands, regardless of the use of pulse modulation technology.

Comparison of immediate (inpatient) and long-term results of open and laparoscopic retropubic prostatectomies in surgical treatment of benign prostatic hyperplasia

Annotation. The purpose of the study is to compare and evaluate the immediate (inpatient) and long-term results of open and laparoscopic retropubic prostatectomy in the surgical treatment of large benign prostatic hyperplasia (more than 80 ml). The immediate (inpatient) and long-term (after discharge from the hospital and up to 2 years of follow-up) results of one-time laparoscopic extraperitoneal retropubic prostatectomy in 50 patients with benign prostatic hyperplasia who were operated in the Clinical Center of Oncology, Hematology, Transplantology and Palliative Care of the Cherkasy Regional Council and urological department of the Vinnytsia Regional Hospital named after M. Pirogov in the period from 2021 to 2023, as well as 120 one-time open retropubic prostatectomies in patients with benign prostatic hyperplasia who were operated in the urological department of the Vinnytsia Regional Hospital named after M. Pirogov for the same period of time. The average time of laparoscopic prostatectomy was 120.3±11.7 minutes, open – 81.1±17.4; average intraoperative blood loss – 118.7±33.6 ml and 520.5±67.4 ml, postoperative bed-day 6.1±1.1 and 9.8±2.9, respectively. Transfusion of blood components due to blood loss was performed in 9 (7.5%) patients after open retropubic prostatectomy, never after laparoscopic. Urological complications after laparoscopic prostatectomy were noted in 2% of patients, open - 19.2%, complications according to Clavien-Dindo – 4% and 33.3%, respectively. According to the conducted uroflowmetry, it was noted that laparoscopic and open retropubic prostatectomies allow equally effective restoration of urination in patients after surgery. When analyzing the long-term results of treatment of patients with benign prostatic hyperplasia, fewer (2.5% versus 8%) postoperative complications were noted after laparoscopic pubic prostatectomy.

Role of Thulium Laser and Holmium Laser in the Surgical Treatment of Benign Prostatic Hyperplasia: A Systemic Review and Meta-Analysis.

Patients with benign prostatic hyperplasia are generally treated holmium laser enucleation of the prostate (HoLEP) and thulium laser enucleation of the prostate (ThuLEP). Therefore, it is important to analyze the several surgical procedures used for benign prostatic hyperplasia in terms of their role, effectiveness and safety. We conducted a meta-analysis by searching databases of PubMed, Google Scholar, and Web of Science. Finally, we selected 10 papers including 2,456 patients treated with of thulium laser and holmium laser in the surgical treatment of benign prostatic hyperplasia. We did the analysis using RevMan 5.0 with the selected studies until 26 October 2023. ThuLEP resulted in a smaller reduction in haemoglobin (MD: -0.22, 95%CI -0.32 to -0.13, P<0.001) and a shorter hospital stay (MD: -0.29, 95%CI -0.38 to -0.20, P <0.001). During the postoperative follow-ups, only the IPSS (MD: -0.03; 95%CI -0.11 to -0.06; P 0.58) at the six-month showed statistically significant differences. ThuLEP has greater security and faster growth than HoLEP.

Acute Oral Toxicological Profile of Croton membranaceus Mull. Arg. Aqueous Stem Extract, a Herbal Treatment for Benign Prostate Hyperplasia, in Male Sprague-Dawley Rats.

Croton membranaceus Mull. Arg. is a traditional medicinal plant frequently employed in Ghana for the treatment of benign prostatic hyperplasia and prostate cancer. The objective of this study was to determine the acute oral toxicity of the aqueous stem extract of Croton membranaceus (CMASE) in male Sprague-Dawley (S-D) rats. The acute toxicity of CMASE was evaluated using S-D rats randomly divided into four groups of five animals each. Three groups (low dose, median dose, and high dose) of rats received single oral doses of CMASE (1000, 2500, and 5000 mg/kg body weight, respectively) using an oral gavage. The control group was given distilled water. After 14 days of daily observations, hematological, biochemical, and histopathological analyses were conducted on the rats. From the results obtained, doses of CMASE up to 5000 mg/kg did not cause death or induce any clinical indications of toxicity during the study period. Also, the mean body weight and the hematological indices assessed were not significantly affected by the various doses of CMASE compared to the control group. However, serum uric acid and creatinine levels decreased significantly (p < 0.001) 14 days after the extract administration. Serum liver function enzyme levels, including alkaline phosphatase (ALP), alanine aminotransferases (ALT), and aspartate aminotransferases (AST), and serum proteins (total proteins and albumin) exhibited significant (p < 0.001) non dose-dependent changes (increases and decreases) in treated groups compared to the controls. Other biochemical indices, however, did not differ significantly between the treated groups and the controls. The gross pathological and histological analysis of the heart, liver, and kidney tissues did not reveal any significant changes in histoarchitecture. The oral LD50 of CMASE in rats was greater than 5000 mg/kg, indicating that the extract was relatively safe. It must, however, be used with care as a substitute for the roots.

Cost-effectiveness analysis of minimally invasive surgical treatments for benign prostatic hyperplasia: implications for Japan’s public healthcare system

Aims Benign prostatic hyperplasia (BPH) represents a significant public health issue in Japan. This study evaluated the lifetime cost-effectiveness of water vapor energy therapy (WAVE) versus prostatic urethral lift (PUL) for men with moderate-to-severe BPH from a public healthcare payer’s perspective in Japan. Materials and methods A decision analytic model compared WAVE to PUL among males in Japan. Clinical effectiveness and adverse event (AE) inputs were obtained from a systematic literature review. Resource utilization and cost inputs were derived from the Medical Data Vision database and medical service fee national data in Japan. Experts reviewed and validated model input parameters. One-way and probabilistic sensitivity analyses were conducted to determine how changes in the values of uncertain parameters affect the model results. Results Throughout patients’ lifetimes, WAVE was associated with higher quality-adjusted life years (0.920 vs. 0.911 year 1; 15.564 vs. 15.388 lifetime) and lower total costs (¥734,134 vs. ¥888,110 year 1; ¥961,595 vs. ¥1,429,458 lifetime) compared to PUL, indicating that WAVE is a more effective and less costly (i.e. dominant) treatment strategy across all time horizons. Lifetime cost-savings for the Japanese healthcare system per patient treated with WAVE instead of PUL were ¥467,863. The 32.7% cost difference between WAVE and PUL was predominantly driven by lower WAVE surgical retreatment rates (4.9% vs. 19.2% for WAVE vs PUL, respectively, at 5 years) and AE rates (hematuria 11.8% vs. 25.7%, dysuria 16.9% vs. 34.3%, pelvic pain 2.9% vs. 17.9%, and urinary incontinence 0.4% vs. 1.3% for WAVE vs PUL, respectively, at 3 months). Model findings were robust to changes in parameter input values. Limitations The model represents a simplification of complex factors involved in resource allocation decision-making. Conclusions Driven by lower retreatment and AE rates, WAVE was a cost-effective and cost-saving treatment for moderate-to-severe BPH in Japan compared to PUL, providing better outcomes at lower costs to the healthcare system.