prostate is a small, walnut-sized structure that forms part of the male
reproductive system. Benign prostatic hyperplasia (BPH) is a condition in which
the prostate gland grows enlarges. Increase in size of the gland occurs in
older ages resulting in difficulty with urination. About 50% of men have
microscopic evidence of BPH by the age of 50, it gets
commoner thereafter. BPH is a non-cancerous condition; it doesn't raise the
risk of prostate cancer. The exact cause is still unclear.
intervention remains the mainstay of treatment for BPH in patients with
moderate-to-severe lower urinary tract symptoms and BPH-related complications.
It is more effective than any of the medical therapies available, and most
people wish to pursue the most effective therapy as a primary treatment,
especially when the symptoms are bothersome. The procedure called transurethral resection
of prostate (TURP) is considered as the gold standard for surgical management
In TURP, the prostate gland (or a part of it) is removed through the urethra.
TURP is known to have a very high success rate in producing symptom relief and
has been in vogue ever since its introduction in the 1960s.
complications produced by TURP have forced researchers to search for methods
that retained the efficacy but cut down the adverse events. Increased risk of
bleeding, blood transfusions, urinary incontinence, retrograde ejaculation and
prolonged hospital stay are the important complications of TURP. Recent years
have seen the advent of a number of new surgical options. Development of drug
therapies and minimally invasive techniques has brought about a decrease in the
number of TURPs performed worldwide.
simple prostatectomy, one of the oldest interventions, is still considered a
recommended treatment in some cases of enlarged prostate.
laparoscopic simple prostatectomy was described in 2002. Laparoscopic surgeries
are performed through tiny incisions in the body. They allow shorter hospital
stay and time of catheterisation. Reduction in bleeding is also an advantage.
modifications led to the development of the new technique of robotic-assisted simple
prostatectomy (RASP). Functional outcome of RASP is highly encouraging. Medical
applicability of LASER produced an alternative to TURP. Prostate laser
vaporization evolved in the last 15 years. Laser resections can be performed
using different energy sources. A number of studies have evaluated the efficacy
and complications unique to each source.
yttrium-aluminium-garnet (Nd:YAG) laser, for example, is associated with
painful urination and longer catheterisation following surgeries. The green
light laser HPS 120W represents the latest innovation and is useful even for
prostates larger than 80g.
Traditional TURP also
has a worthy alternative called TUR holmium laser enucleation of the prostate
(HoLEP). It is known to be a safe and effective procedure for treating
symptomatic BPH. It is useful irrespective of prostate size, and allows shorter
hospital stay. HoLEP, however demands significant experience and training.
Robotic and laparoscopic
approaches continue to be investigated. Patients who cannot tolerate operative
procedures have the choice of minimally invasive techniques. These
techniques do not require anaesthesia. The concept of killing prostatic tissues
using heat energy, thermotherapy, appears to be effective.
changes induced by heating depend on the temperature achieved in the tissue. Thermocoagulation
is attained above 45 degrees. The failure of the transrectal or transurethral
hyperthermia devices prompted researchers to develop transurethral microwave
heat treatment. The Prostatron device received approval after
five years of rigorous testing.
Treatment with the
Prostatron device takes about 60 minutes, and delivers up to 60 W. Its
treatment catheter emits a radio frequency of 1296MHz via a 3.4 cm microwave
antenna. Another modality called the Targis system uses a cooled
microwave thermotherapy to treat BPH. Precisely directed microwaves cause
coagulative necrosis (a type of tissue death) of the prostate tissue. The
cooled water employed allow faster recovery times and better patient comfort.
CoreTherm (ProstaLund) is a way to use microwave thermotherapy by
monitoring the actual temperature in prostate tissue during treatment.
Specially designed intraprostatic temperature probes are employed for this.
CoreTherm allows treatment to be highly individualized and controlled. It can
be stopped when adequate tissue destruction is achieved.
needle ablation (TUNA) is employed as an outpatient
procedure. During TUNA, a special visual instrument called cystoscope is
inserted through the tip of penis into the urethra (the tube that carries urine
from bladder). Tiny needles are guided into the prostate and radio waves are
passed through them. Radio waves create scar in the prostate tissue thereby
shrinking the enlarged gland. This opens up the urinary channel so that urine
can flow more easily.
thermotherapy (transurethral microwave therapy; TUMT) are effective
alternatives to TURP for treating symptomatic BPH in men with no history of
urinary retention or previous prostatic procedures.
the evolving strategies for treatment of BPH, open prostatectomy and TURP stand
the tests of time. They remain as gold standards and serve as references for
comparison of newer
Reference: Recent Advances in Surgery for Benign
Prostatic Hyperplasia; Bernardo et al; Ther Adv Urol. (6):263-272