Surgical treatment of benign prostatic hyperplasia: modern methods and potentials

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.

1. Unnikrishnan R, Almassi N, Fareed K. Benign prostatic hyperplasia: evaluation and medical management in primary care. Cleve Clin J Med. 2017;84:53-64. DOI: 10.3949/ccjm.84a.16008

2. AV Iliash, MB Chibichyan, MI Kogan. Prostatic cancer detected at surgical treatment for prostatic adenoma. Urologiia. 2012;1:54-58. (In Russ.). eLIBRARY ID: 17706087

3. Na R, Helfand BT, Chen H, Conran CA, Crawford SE , Hayward SW , Tammela T, Hoffman-Bolton J, Zheng SL , Walsh PC, Schleutker J, Platz EA , Isaacs WB, Xu J. A genetic variant near GATA3 implicated in inherited susceptibility and etiology of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Prostate 2017;77:1213-1220. DOI: 10.1002/pros.23380

4. Qian X, Liu H, Xu D, Xu L, Huang F, He W, Qi J, Zhu Y, Xu D. Functional outcomes and complications following B-TURP versus HoLEP for the treatment of benign prostatic hyperplasia: a review of the literature and meta-analysis. Aging Male. 2017;20(3):184-191. DOI: 10.1080/13685538.2017.1295436

5. Rieken M, Kaplan SA. Enucleation, Vaporization, and Resection: How To Choose the Best Surgical Treatment Option for a Patient with Male Lower Urinary Tract Symptoms. Eur Urol Focus. 2018;4(1):8-10. DOI: 10.1016/j.euf.2018.04.020

6. Stone BV, Chughtai B, Kaplan SA, Te AE, Lee RK. GreenLight laser for prostates over 100 ml: what is the evidence? Curr Opin Urol. 2016;26(1):28-34. DOI: 10.1097/MOU.0000000000000237

7. . Cornu JN, Ahyai S, Bachmann A, de la Rosette J, Gilling P, Gratz-ke C, McVary K, Novara G, Woo H, Madersbacher S. A systematic review and metaanalysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulti ng from benign prostatic obstruction: an update. Eur Urol. 2015;67(6):1066-1096. DOI: 10.1016/j.eururo.2014.06.017

8. Gilling PJ, Cass CB, Malcolm AR, Fraundorfer MR: Combination Holmium and Nd:YAG laser ablation of the prostate: Initial clinical experience. J Endourol. 1995;9:151-153. DOI: 10.1089/end.1995.9.151

9. Chun SS, Razvi HA, Denstedt JD. Laser prostatectomy with the holmium: YAG laser. Techn Urol. 1995;1:217-221. PMID: 9118394

10. Gilling PJ, Fraundorfer MR. Holmium laser prostatectomy: a technique in evolution. Curr Opin Urol. 1998;8(1):11-15. PMID: 17035836.

11. Tubaro A, de Nunzio C. The current role of open surgery in BPH. EAU-EBU Update Series. 2006;4:191-201. DOI: 10.1016/j.eeus.2006.07.002

12. Tan A, Liao C, Mo Z, Cao Y. Meta-analysis of holmium laser enucleation versus transurethral resection of the prostate for symptomatic prostatic obstruction. Br J Surg. 2007;94:1201-1208. DOI: 10.1002/bjs.5916

13. Elkoushy MA, Elshal AM, Elhilali MM. Reoperation After Holmium Laser Enucleation of the Prostate for Management of Benign Prostatic Hyperplasia: Assessment of Risk Factors with Time to Event Analysis. J Endourol. 2015;29(7):797-804. DOI: 10.1089/end.2015.0060

14. Herrmann TR, Bach T, Imkamp F, Georgiou A, Burchardt M, Oelke M, Gross AJ. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction. World J Urol. 2010;28(1):45-51. DOI: 10.1007/s00345-009-0503-0

15. Kyriazis II,'Swiniarski PP, Jutzi S, Wolters M, Netsch C, Burchardt M, Liatsikos E, Xia S, Bach T, Gross AJ, Herrmann TR. Transurethral anatomical enucleation of the prostate with Tm:YAG support (ThuLEP): review of the literature on a novel surgical approach in the management of benign prostatic enlargement. World J Urol. 2015;33(4):525-530. DOI: 10.1007/s00345-015-1529-0

16. Kuntzman RS, Malek RS, Barrett DM, Bostwick DG. High-power (60-watt) potassium-titanyl-phosphate laser vaporization prostatectomy in living canines and in human and canine cadavers. Urology. 1997;49(5):703-708. DOI:10.1016/s0090-4295(97)00232-x

17. Chughtai B, Te A. Photoselective vaporization of the prostate for treating benign prostatic hyperplasia. Expert Rev Med Devices. 2011;8(5):591-595. DOI: 10.1586/erd.11.25.

18. Lee DJ, Rieken M, Halpern J, Zhao F, Pueschel H, Chughtai B, Kaplan SA, Lee RK, Bachmann A, Te AE. Laser vaporization of the prostate with the 180-W XPS-Greenlight laser in patients with ongoing platelet aggregation inhibition and oral anticoagulation. Urology. 2016;91:167-173. DOI: 10.1016/j.urology.2016

19. Tao H, Jiang YY, Jun Q, Ding X, Jian DL, Jie D, Ping ZY. Analysis of risk factors leading to postoperative urethral stricture and bladder neck contracture following transurethral resection of prostate. Int Braz J Urol. 2016;42(2):302-311. DOI: 10.1590/S1677-5538.IBJU.2014.0500

20. Michielsen DP, Coomans D. Urethral strictures and bipolar transurethral resection in saline of the prostate: fact or fiction? J Endourol. 2010;24(8):1333-7. DOI: 10.1089/end.2009.0575

21. Lee YH, Chiu AW, Huang JK. Comprehensive study of bladder neck contracture after transurethral resection of prostate. Urology. 2005;65:498-503;discussion 503. DOI: 10.1016/j.urol-ogy.2004.10.082

22. Ruszat R, Wyler SF, Seitz M, Lehmann K, Abe C, Bonkat G, Reich O, Gasser TC, Bachmann A. Comparison of potassium-titanyl-phosphate laser vaporization of the prostate and transurethral resection of the prostate: update of a prospective non-randomized two-centre study. BJU Int. 2008;102:1432-8;discus-sion 1438-1439. DOI: 10.1111/j.1464-410X.2008.07905.x

23. Nielsen KK, Nordling J. Urethral stricture following transurethral prostatectomy. Urology. 1990;35:18-24. DOI: 10.1016/0090-4295(90)80005-8

24. Hammarsten J, Lindqvist K, Sunzel H. Urethral strictures following transurethral resection of the prostate. The role of the catheter. Br J Urol. 1989;63(4):397-400. PMID: 2713622

25. Goodwin MI, Chester JF. Meatal strictures after transurethral prostatectomy using latex or polyvinyl chloride three-way catheters. Ann R Coll Surg Engl. 1990;72(2):125-157. PMID: 2185681

26. Tan GH, Shah SA, Ali NM, Goh EH, Singam P, Ho CCK, Zainuddin ZM. Urethral strictures after bipolar transurethral resection of prostate may be linked to slow resection rate. Investig Clin Urol. 2017;58(3):186-191. DOI: 10.4111/icu.2017.58.3.186

27. Grechenkov AS, Zharikov TM. Diabetes mellitus as one of the risk factors for the development of urethral strictures after transurethral resection of the prostate. Medical Bulletin of Bashkortostan. 2015;10(3):24-27. (In Russ.). eLIBRARY ID: 24245580

28. Song W, Wang T, Ling Q, Liu XM, Chen Z, Song XD, Guo XL, Zhuang QY, Wang SG, Liu JH.Thulium laser vaporization versus transurethral resection of the prostate and risk factors for postoperative urethral stricture. Zhonghua Nan Ke Xue. 2017;23(12):1085-1088. PMID: 29738178

29. Wilson LC, Gilling PJ, Williams A, Kennett KM, Frampton CM, Westenberg AM, Fraundorfer MR. A randomised trial comparing holmium laser enucleation versus transurethral resection in the treatment of prostates larger than 40 grams: results at 2 years. Eur Urol. 2006;50:569-573. DOI: 10.1016/S0084-4071(08)70089-7

30. Montorsi F, Naspro R, Salonia A, Suardi N, Briganti A, Zanoni M, Valenti S, Vavassori I, Rigaffi P. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J Urol. 2008;179(5 Suppl):S87-90. DOI: 10.1016/j.juro.2008.03.143

31. Ukhal MI. Оп the advisability of reinforcing pathogenetically substantiated medication prophylaxis for complications after surgical treatment of prostatic hyperplasia. Health of Men. 2017;4(63):48-50. DOI: 10.30841/2307-5090.4(63)

32. Filimonov VB, Vasin RV, Sobennikov IS. The growth of antibiotic resistance of microorganisms in patients with benign prostatic hyperplasia as a medical and social problem. Science of the Young (Eruditio Juvenium). 2019;7(1):106-112. (In Russ.). eLIBRARY ID:37145223

33. Wagenlehner FME, Wagenlehner C, Schinzel S, Naber KG. Prospective, randomized, multi centric, open, comparative study on the efficacy of a prophylactic single dose of 500 mg levoflox-acin versus 1920 mg trimethoprim/ sulfamethoxazole versus a control group in patients undergoing TUR of the prostate. Eur. Urol. 2005;47:549-556. DOI: 10.1016/j.eururo.2005.01.004

34. Ahyai SA, Gilling P, Kaplan SA, Kuntz RM, Madersbacher S, Montorsi F, Speakman MJ, Stief CG. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur Urol. 2010;58(3):384-397. DOI: 10.1016/j.eururo.2010.06.005

35. Kikuchi M, Kameyama K, Yasuda M, Yokoi S, Deguchi T, Miwa K. Postoperative infectious complications in patients undergoing holmium laser enucleation of the prostate: Risk factors and microbiological analysis. Int J Urol. 2016;23(9):791-796. DOI: 10.1111/iju.13139

36. Nashivochnikova NA, Krupin VN, Klochai VV. The state of microcirculation of the bladder neck in patients with BPH. Medical Journal of Bashkortostan. 2011;6(2):267-271. (In Russ.). eLI-BRARYID: 16332168

37. Sun F, Sun X, Shi Q, Zhai Y. Transurethral procedures in the treatment of benign prostati c hyperplasia: A systematic review and meta-analysis of effectiveness and complications. Medicine (Baltimore). 2018;97(51):e13360. DOI: 10.1097/MD.0000000000013360.

38. Yang Z, Wang X, Liu T. Thulium laser enucleation versus plas-makinetic resection of the prostate: a randomized prospective trial with 18-month follow-up. Urology. 2013;81:396-400. DOI: 10.1016/j.urology.2012.08.069

39. Zhang FB, Shao Q, Tian Y. Comparison of the diode laser and the thulium laser in transurethral enucleation of the prostate for treatment of benign prostatic hyperplasia. Beijing Da Xue Xue Bao. 2013;45:592-596. PMID: 23939169

40. Thomas JA, Tubaro A, Barber N, d'Ancona F, Muir G, Witzsch U, Grimm MO, Benejam J, Stolzenburg JU, Riddick A, Pahernik S, Roelink H, Ameye F, Saussine C, Bruyere F, Loidl W, Larner T, Gogoi NK, Hindley R, Muschter R, Thorpe A, Shrotri N, Graham S, Hamann M, Miller K, Schostak M, Capitan C, Knispel H, Bachmann A. A multicenter randomized noninferiority trial comparing GreenLight-XPS laser vaporization of the prostate and transurethral resection of the prostate for the treatment of benign prostatic obstruction: two-yr outcomes of the GOLIATH study. Eur Urol. 2016;69:94-102. DOI: 10.1016/j.eururo.2015.07.054

41. Al-Ansari A, Younes N, Sampige VP, Al-Rumaihi K, Ghafouri A, Gul T, Shokeir AA. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol. 2010;58:349-355. DOI: 10.1016/j.eururo.2010.05.026

42. Capitan C, Blazquez C, Martin MD, Hernandez V, de la Pena E, Llorente C. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: a randomized clinical trial with 2-year follow-up. Eur Urol 2011;60:734-739. DOI: 10.1016/j.eururo.2011.05.043

43. Zakhmatov YuM, Varentsov GI, Otvetchikov AI, Kornev AI. The dynamics of IPSS after various types of surgical treatment of BPH. In: Materials of the X Russian Congress of Urology. M; 2002; with. 112-114. (In Russ.).

44. Sorokin DA, Puchkin AB, Semenychev DV, Karpuhin IV, Kochkin AD, Zorin DG, Sevrukov FA. Hyaluronic acid in the treatment and prevention of postoperative complications of endoscopic operations for benign prostatic hyperplasia. STM 2015;7(4). (In Russ.). eLIBRARY ID: 25140936

45. Abaev YuK. Diabetes mellitus and wound healing. Medical news. 2010; 1(31): 107-110. (In Russ.). eLIBRARY ID: 21039075