Ces Urol 2020, 24(3):191-206 | DOI: 10.48095/cccu2020028

Minimally invasive surgical methods for the treatment of benign prostatic hyperplasia, as an alternative to classic desobstructive procedures

Lukáš Fišer¹, Milan Čermák¹, Lubomír Hyršl¹, Jiří Kočárek^1,2

¹ Urologické oddělení, Oblastní nemocnice Kladno, a. s., Kladno

² Urologická klinika, 1. lékařská fakulta, Univerzita Karlova v Praze

Fišer L, Čermák M, Hyršl L, Kočárek J. Minimally invasive surgical methods for the treatment of benign prostatic hyperplasia as an alternative to classic desobstructive procedures. Since 1885 and 1886, when Belfield and Dittel performed the first transvesical prostatectomy (TVPE) described in the literature, and since 1926, when Maximilian Stern performed the first transurethral resection of the prostate (TURP), these techniques are considered the "gold standard" in surgical treatment of benign prostatic enlargement (BPH). Both surgical methods lead to a significant improvement in subjective, functional and laboratory results, namely a reduction in the International Prostate Symptom Score Questionnaire (IPSS), an increase in maximum urine flow rate (Qmax), a reduction in post-micturition residue volume (PMR), a reduction in prostate volume (PV) and in some cases to reduce the value of prostate specific antigen (PSA). Nevertheless, we would find here several "defects in beauty". The main disadvantages of the above surgical procedures include the need for hospitalization, anesthesia and bladder catheterization, plus high perioperative morbidity and possible postoperative complications such as bleeding, infections, urinary retention, urinary incontinence, urethral strictures and sexual dysfunction. Therefore, many new surgical techniques have been developed over the years to minimize these shortcomings. Some of them have entered the standard algorithm for surgical treatment of BPH, such as transurethral prostate enucleation (TUEP), prostate enucleation by holmium laser (HoLEP) or thulium laser (ThuLEP), or photoselective prostate vaporization (PVP). Others have not been fully established, such as transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA) and prostate stents. Despite the excellent surgical results of the above-mentioned desobstructive procedures in the treatment of BPH, there remain a number of men who cannot or do not want to undergo them. The most common reasons for the impossibility of performing surgical treatment include the patient's polymorbidity, fear of possible perioperative and postoperative complications. That is why there is intensive development of new minimally invasive surgical techniques that would not require hospitalization, anesthesia and catheterization and at the same time would lead to a reduction or elimination of side effects of standard surgical treatment of BPH. These methods include the AquaBeam® system, the UroLift® system, the Rezūm® system and the TIND system.

Keywords: AquaBeam®, benign prostate hyperplasia (BPH), minimally invasive surgical methods, Rezūm®, TIND, UroLift®.

Received: July 17, 2020; Revised: September 6, 2020; Accepted: September 15, 2020; Published: October 2, 2020