Treatment Of Prostatic Obstruction Research Articles

Short-term report on transurethral diode laser vaporization of the prostate at Ahmadu Bello University Teaching Hospital, Zaria-Nigeria

Background: Laser vaporization of the prostate is an evolving addition to the armamentarium for prostate surgery. This is despite the availability of cheaper treatment modalities such as open prostatectomy and transurethral resection of the prostate (TURP). However, diode laser vaporization in this regard has the advantages of a shorter learning curve and minimal complications. This paper was aimed at assessing the effectiveness of this mode of therapy and to share our initial experience with this procedure. Patients and Methods: This was a prospective study carried out over a period of 18 months. All men requiring surgery for bothersome prostatic obstruction with benign prostate size ≤100 g were included. Those with malignant prostatic obstruction irrespective of size were also included. The exclusion criteria were benign prostate of size >100 g, and indication for open prostatectomy/channelization or medical therapy. Clearance was obtained from the Health Research Ethics Committee of the institution and informed consent was obtained from all the patients. Each patient's demographics and pre-, intra-, and post-operative details were entered into a pro forma. Results were analyzed using descriptive statistics. Results: Eleven men were included in this study, aged 59-81 years with a mean of 67 years. 63.6% had benign prostatic hyperplasia (BPH) while the remaining 36.4% had carcinoma of the prostate. The mean prostate size was 88 g with a range of 54-182 g. Main symptoms were severe or bothersome lower urinary tract symptoms (LUTS). The mean operating time (lasing time) was 65 min. There were no intraoperative complications and none required blood transfusion. Most had irrigation for only 24 h, one didn't require irrigation while two others required irrigation for 48 h and 72 h, respectively. Out of all the patients, 90.9% had catheter removed at ≤48 h, while one had catheter removed on the fifth postoperative day. All except one were discharged at 72 h or less postoperatively. All the patients had satisfactory subjective outcome at a mean follow-up of 9 months with a range of 1 to 18 months. Conclusion: We found transurethral laser vaporization of the prostate to be effective and safe in the treatment of prostatic obstruction. However, a study involving larger number of patients and longer follow-up will establish its true place in the management of prostatic obstruction in our environment.

Critical appraisal of the Spanner™ prostatic stent in the treatment of prostatic obstruction.

The Spanner™ stent was first used in patients to relieve bladder outlet obstruction (BOO), and has recently been used in patients following transurethral microwave thermotherapy and men unfit for surgical intervention. We review the current literature on the role of the Spanner stent in treating prostatic obstruction compared to previously reported cases involving the use of temporary stents. The Spanner stent has been found to be successful in treating patients with bladder outlet obstruction from benign prostatic hyperplasia and following high-energy transurethral microwave thermotherapy (TUMT). Patients with the Spanner stent had an increase in peak flow rate and a decrease in post void residual and International Prostate Symptom Scores. In patients treated with TUMT, quality of life measures indicate that the Spanner stent shows increased ease of bladder drainage, decreased leakage, and no adverse effect on daily activities. In patients unfit for surgery, however, there was increased retention and pain requiring stent removal in 63% of cases. The Spanner stent offers ease of insertion with a decrease in voiding symptoms in selected patients. Based on limited data, the Spanner stent has been recommended as a treatment option for men with BOO following TUMT. However, it is not a good treatment option for men unfit for surgery based on an increased incidence of urinary retention and dysuria. The Spanner stent is the only currently approved temporary stent and, based on a literature review, it does not offer significant advantage over previously used temporary stents. It is notable that most researchers have not evaluated the role of detrusor function on the outcomes.

The use of bipolar PlasmaKinetic resectoscope in endoscopic resection of the prostate: our experience

Prostatic endoscopic resection (TURP) is a reference method in the treatment of prostatic obstruction. In the past decades, the method used a monopolar resectoscope. In the last years, various technologies have been studied to improve the efficacy of endoscopic resection. As per our experience, we have thence ascertained the variations of the hematic crasis and of the mictional asset in TURP patients treated with bipolar knives. 20 patients underwent bipolar plasmakinetic resection of the prostate. Their age ranged between 58 yrs and 82 yrs (av: 70.2 yrs), the adenoma volume, checked with TR ultrasound scanning, was between 33 and 44 cc (av: 37.6), the Qmax was between 6.4 and 9.0 mL/min (av.: 7.42 mL/min). A 24Ch resectoscope and spinal anesthesia were used. Bleeding during resection was never relevant; therefore resection never had to be stopped. After about 36 hours from surgery, the patients’ sanguification was checked again: a 6.53% reduction of the number of erythrocytes, compared to pre-surgery data, was observed, together with a 6.73% decrease of hemoglobin concentration, and a 6.3% decrease of hematocrit. Continuous irrigation was suspended during the first day, catheter was removed on the 48th hour in 15 cases, and on the 72nd in 5 cases: the patients were discharged on day 3 in 16 cases, and on day 4 in 4 cases. A flux evaluation was performed after 3 months, which showed a Qmax between 16.6 and 24 mL/min (av.: 19.11), with a significant increase in the maximum flow rate. The use of the new technologies in prostatic endoscopic resection has allowed us to improve the efficacy of such a method. Above all, the use of a bipolar electrosurgical knife enables us to associate a basal hemostasis with the resection of the prostatic tissue. Thus, the hematic loss is low, as we have been able to ascertain also in our own experience. This gave us the possibility to quickly stop continuous irrigation and to early remove the catheter. This way, hospitalization was sensibly reduced (av. 76.8 hours). The maximum flow rate, in the short term, has been good. We have been able, in our experience, to assess that this technology represents a useful guarantee to improve the results of prostatic endoscopic resection.

The use of bipolar PlasmaKinetic resectoscope in endoscopic resection of the prostate: our experience

Prostatic endoscopic resection (TURP) is a reference method in the treatment of prostatic obstruction. In the past decades, the method used a monopolar resectoscope. In the last years, various technologies have been studied to improve the efficacy of endoscopic resection. As per our experience, we have thence ascertained the variations of the hematic crasis and of the mictional asset in TURP patients treated with bipolar knives. 20 patients underwent bipolar plasmakinetic resection of the prostate. Their age ranged between 58 yrs and 82 yrs (av.: 70.2 yrs), the adenoma volume, checked with TR ultrasound scanning, was between 33 and 44 cc (av.: 37.6), the Qmax was between 6.4 and 9.0 mL/min (av.: 7.42 mL/min). A 24Ch resectoscope and spinal anesthesia were used. Bleeding during resection was never relevant; therefore resection never had to be stopped. After about 36 hours from surgery, the patients' sanguification was checked again: a 6.53% reduction of the number of erythrocytes, compared to pre-surgery data, was observed, together with a 6.73% decrease of hemoglobin concentration, and a 6.3% decrease of hematocrit. Continuous irrigation was suspended during the first day, catheter was removed on the 48th hour in 15 cases, and on the 72nd in 5 cases: the patients were discharged on day 3 in 16 cases, and on day 4 in 4 cases. A flux evaluation was performed after 3 months, which showed a Qmax between 16.6 and 24 mL/min (av.: 19.11), with a significant increase in the maximum flow rate. The use of the new technologies in prostatic endoscopic resection has allowed us to improve the efficacy of such a method. Above all, the use of a bipolar electrosurgical knife enables us to associate a basal hemostasis with the resection of the prostatic tissue. Thus, the hematic loss is low, as we have been able to ascertain also in our own experience. This gave us the possibility to quickly stop continuous irrigation and to early remove the catheter. This way, hospitalization was sensibly reduced (av. 76.8 hours). The maximum flow rate, in the short term, has been good. We have been able, in our experience, to assess that this technology represents a useful guarantee to improve the results of prostatic endoscopic resection.

Potassium titanyl phosphate laser prostatectomy: a review

High-powered potassium titanyl phosphate laser (GreenLight PV) has gained attention as a minimal access alternative for the treatment of prostate obstruction. This article reviews the recent data and technical refinements of potassium titanyl phosphate laser prostatectomy. The technique is similar to transurethral resection of the prostate in improving symptoms and urinary flow but with minimal morbidity. Striking advantages of this technique include minimal catheter times, true day-case surgery and the virtual abolition of blood transfusions. The absence of intraoperative irrigant absorption (transurethral resection syndrome) in this technique allows high-risk patients, or those with massive prostates, to be safely treated with minimal hospitalization. The availability of a safe and effective technique to overcome the considerable drawbacks of open prostatectomy and transurethral resection of the prostate is a major advance. Although randomized studies are limited, multicentre prospective data from a variety of clinical settings show similar benefits and promising durability over 3-5 years.

The treatment of prostatic obstruction other than by enucleation

The treatment of prostatic obstruction other than by enucleation

Chemo-Ablation of the Prostate With Dehydrated Alcohol for the Treatment of Prostatic Obstruction

Chemo-Ablation of the Prostate With Dehydrated Alcohol for the Treatment of Prostatic Obstruction

A new, large calibre, self-expanding and self-retaining temporary intraprostatic stent (ProstaCoil) in the treatment of prostatic obstruction.

To determine the benefits of a new self-expanding and self-retaining large calibre temporary intraprostatic coil stent in patients with bladder outflow obstruction due to benign prostatic hypertrophy. Sixty-five patients with bladder outflow obstruction have been studied with a follow-up period of 3-28 months (mean 16). Thirty patients became eligible for surgery and had their stent removed without difficulty 3-12 months after stent insertion. Only one stent was removed because of urgency and incontinence. Stent repositioning was required in five patients and 14 complained of temporary dysuria or perineal pain. Twenty-seven patients continue to pass urine through their stent without difficulty. Because of its large diameter and its temporary nature this new stent allows endoscopic examination of the bladder and has few side effects. This stent should be considered as an alternative to a urethral catheter or other temporary stents in patients who are unfit for surgery.

前立腺肥大症に対するHo: YAGレーザー組織内照射による治療の基礎的検討

To develop a new transperineal laser prostatectomy through a biopsy needle, we evaluated the efficacy of pulsed Ho: YAG laser irradiation for the canine prostate. The Ho: YAG laser may induce stress-wave to destroy the small vessels in the prostate. Seventeen mongrel dogs were used. After a lower midline abdominal incision, the prostate was punctured with a 18G biopsy needle in parallel to the urethra. Two prostates were punctured without the irradiation as a control. One of the 15 treated prostates was removed immediately after high fluence irradiation (500J/cm2) in left lobe and low (150J/cm2) in right lobe. In 12 of 15 dogs, each lobe of the prostate was irradiated with high fluence. In 2 of 15 dogs, each lobe of the prostate was irradiated with low fluence. The treated prostates were removed immediately, 1 week, 1 month and 2 months after the irradiation. The high fluence irradiation resulted in the sufficient volume reduction (40%) and the huge cavities were created I month later. The low fluence irradiation showed only the inflammatory reaction. The histological examination showed that the hemorrhage and subsequent histological changes may be caused by the laser induced stress-wave rather than by thermal effect. Our results suggest that transperineal irradiation with pulsed Ho: YAG laser can be useful in the treatment of prostatic obstruction.

Comparative Study of Selective α1‐Adrenoceptor Blockade versus Surgery in the Treatment of Prostatic Obstruction

Alternative treatments for benign prostatic hyperplasia (BPH) are the source of much discussion at present. Pharmacotherapy has been demonstrated to have an increasing role in the management of BPH. This study contrasts the efficacy of the selective alpha antagonist prazosin as compared with placebo and the subsequent improvements seen following surgical treatment. Whilst selective alpha blockade has undoubted therapeutic efficacy the improvement in symptom scores and the objective urodynamic measure of the flow rate are not as marked as those seen following surgery.

A 12-Week Placebo-controlled Double-blind Study of Prazosin in the Treatment of Prostatic Obstruction due to Benign Prostatic Hyperplasia

A 12-Week Placebo-controlled Double-blind Study of Prazosin in the Treatment of Prostatic Obstruction due to Benign Prostatic Hyperplasia

Clinical Overview of Prazosin in the Treatment of Prostatic Obstruction

Prazosin is well known to most physicians as an effective antihypertensive medication, but its therapeutic value in many cases of benign prostatic hyperplasia (BPH) may be unfamiliar to many. Prostate problems are among the most common medical conditions facing older men, with BPH appearing in more than 50% of men over the age of 50 years and in 90% of those over 80 years of age. About 10% of men over the age of 40 undergo surgery for the condition. Research in the past 15 years has revealed that smooth muscle contractions in the enlarged prostate are controlled by stimulation of the alpha 1-receptors in the tissue. This discovery has provided the rationale for administering drugs to block the stimulation of the alpha 1-receptors to relieve the obstructive and irritative symptoms of BPH. Prazosin was an early candidate for such medication because of its highly selective alpha 1-blockade and its well-documented safety record. Early clinical trials yielded convincing evidence of prazosin's effectiveness in reducing BPH symptoms, and the number of patients treated with prazosin for BPH now numbers in the several hundreds. In these trials, prazosin administered in doses from 1 mg to as high as 9 mg a day relieved obstructive and irritative symptoms, as well as improved flow rates and decreased urethral pressure. Overall, between 60 and 70% of treated patients can be expected to enjoy real benefits from prazosin therapy.

A Twelve-Week Placebo-Controlled Study of Prazosin in the Treatment of Prostatic Obstruction

Fifty-eight normotensive patients with benign prostatic hyperplasia and maximum urinary flow rates of less than 15 ml/s were randomly assigned to receive a 12-week course of treatment with prazosin or placebo in a double-blind parallel group trial. Prazosin was administered orally in doses of 0.5 mg and then 1 mg twice daily for 4 days each and 2 mg twice daily for the remainder of the trial. Patients on treatment with prazosin had an increased urinary flow rate as compared to placebo with a significant reduction in maximum voiding detrusor pressure and maximum detrusor pressure at peak urinary flow. Although a significant effect on frequency was not demonstrated, standard parameters of detrusor instability were reduced. Investigators' double-blind overall assessment of efficacy significantly favoured the prazosin treatment. Twelve patients were excluded from the final analysis, 8 being withdrawn because of adverse effects, 5 on treatment with prazosin and 3 in the placebo group. Oral prazosin appears to be safe and effective in the long-term treatment of patients with benign prostatic hyperplasia.

Prazosin in the Treatment of Prostatic Obstruction: A Placebo-Controlled Study

Eighty patients with prostatic obstruction were entered into a double-blind parallel study of prazosin versus placebo. There were 25 withdrawals or exclusions, leaving 55 patients for analysis. Mean maximum flow rates increased significantly more in patients treated with prazosin than in those treated with placebo (P less than 0.005), but there was no significant reduction in maximum voiding pressure. The mean number of voids, recorded on diary cards, was reduced from an initial 10.0/24 h by 2.1 in the final week, a significantly greater reduction than in the placebo group (P less than 0.01). However, there were no statistically significant changes in the filling cystometrograms. When patients were classified as responders or non-responders in terms of bladder filling, urine flow, bladder emptying, weekly average of voids/24 h and nocturia, the proportion of patients responding to prazosin was significantly greater in all categories except bladder filling and emptying. It was concluded that prazosin at a dose of 2 mg bd is a safe and effective treatment for prostatic obstruction and may be used in patients awaiting surgery and those who are unfit for operation.

Prazosin in the Treatment of Prostatic Obstruction A Placebo‐controlled Study

Eighty patients with prostatic obstruction were entered into a double-blind parallel study of prazosin versus placebo. There were 25 withdrawals or exclusions, leaving 55 patients for analysis. Mean maximum flow rates increased significantly more in patients treated with prazosin than in those treated with placebo (P less than 0.005), but there was no significant reduction in maximum voiding pressure. The mean number of voids, recorded on diary cards, was reduced from an initial 10.0/24 h by 2.1 in the final week, a significantly greater reduction than in the placebo group (P less than 0.01). However, there were no statistically significant changes in the filling cystometrograms. When patients were classified as responders or non-responders in terms of bladder filling, urine flow, bladder emptying, weekly average of voids/24 h and nocturia, the proportion of patients responding to prazosin was significantly greater in all categories except bladder filling and emptying. It was concluded that prazosin at a dose of 2 mg bd is a safe and effective treatment for prostatic obstruction and may be used in patients awaiting surgery and those who are unfit for operation.

Urinary Flow Velocity as an Index of Male Voiding Function

Urinary velocity and urinary peak flow rate developed by 463 male patients were measured before and after treatment for prostatic obstruction, stricture or prostatitis and compared to 121 documented normal males. It was shown that peak flow rate does discriminate partially between the normal and non-normal populations, but that many subjects who presented with ostensibly normal flow rates were actually obstructed when measured by peak urinary velocity. Velocity is shown to be a valuable secondary measurement in the clinic, and the flow velocity vs. flow rate diagram is demonstrated to be a good tool for classifying patients urodynamically.

An Assessment of Cryosurgery in the Treatment of Prostatic Obstruction

An Assessment of Cryosurgery in the Treatment of Prostatic Obstruction

Factors involved in the management of prostatic obstruction.

Mortality and morbidity associated with the treatment of prostatic obstruction are continuously being reduced. In 1953, the highest mortality rate associated with operative relief of prostatic obstruction was less than 4% and was in a city hospital, where the worse risks are always treated; mortality was from 0.83% to less than 2% in other institutions, including large medical centers, open-staffed general hospitals, university hospitals, and a physician-administered hospital. The factors responsible for these impressive figures include antibiotics, antihistamines, stress compensation substances, vitamins, blood transfusions, and, very important, good anesthesia. The management of patients with prostatic obstruction has become so expert that almost any person who is not moribund may be subjected to one of the procedures discussed herein. TYPES OF PROCEDURES Catheterization.— For the patient whose general condition is such that neither the patient nor the physician feels that a surgical procedure is justified, the indwelling urethral catheter will often

Treatment of Prostatic Obstruction

Treatment of Prostatic Obstruction

The Treatment of Prostatic Obstruction

The Treatment of Prostatic Obstruction