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Surgical Treatment for Benign Prostatic Hyperplasia: Holmium Laser Enucleation of the Prostate HoLEP.
Published on: March 6, 2018
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Surgical treatment options for benign prostatic obstruction: beyond prostate volume
Claudia Deyirmendjian1, Dean Elterman2, Bilal Chughtai3
1Faculty of Medicine, University of Montreal, Montreal, Quebec.
Current Opinion in Urology
|October 20, 2021
Summary
Choosing the best benign prostatic obstruction (BPO) treatment involves considering patient-specific factors beyond prostate size. Key considerations include bleeding risk, sexual function preservation, same-day discharge, anesthesia risks, and catheterization duration to personalize BPO surgical options.
Area of Science:
- Urology
- Surgical Innovation
Background:
- Benign prostatic obstruction (BPO) affects a significant number of men.
- Numerous surgical interventions exist for BPO, each with unique profiles.
- Patient-specific factors are crucial for selecting the optimal BPO treatment.
Purpose of the Study:
- To review current surgical treatment options for benign prostatic obstruction (BPO).
- To differentiate BPO procedures based on five key clinical considerations.
- To aid clinicians in selecting the best BPO treatment for individual patients.
Main Methods:
- Comprehensive literature review of 10 BPO procedures.
- Analysis of treatments based on antithrombotic therapy needs.
- Evaluation of procedures regarding sexual function preservation, ambulatory potential, anesthesia risks, and catheterization duration.
Main Results:
- Laser enucleation of the prostate (LEP), bipolar plasma vaporization, and photoselective vaporization (PVP) minimize bleeding risks, suitable for anticoagulated patients.
- Procedures like transurethral incision of the prostate, Rezūm, Aquablation, UroLift, and iTind offer better preservation of ejaculatory function.
- Same-day discharge is feasible with LEP, PVP, and prostatic arterial embolization (PAE).
- UroLift, Rezūm, iTind, and PAE are suitable for patients with high anesthesia risks, often using local anesthesia.
- Shorter catheterization durations are associated with UroLift, PVP, and LEP.
Conclusions:
- The landscape of BPO treatments is rapidly evolving.
- Optimal BPO surgical selection depends on a patient's risk profile, recovery expectations, and desired outcomes.
- Clinical factors beyond prostate volume, including patient values and risk tolerance, are essential for guiding treatment decisions.
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