[Surgical treatment of BPO: Standard and innovations].

Traitements chirurgicaux de l’obstruction prostatique bénigne : standards et innovations.

Publisher: Progrès en urologie, S.A.R.L Country of Publication: France NLM ID: 9307844 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1166-7087 (Print) Linking ISSN: 11667087 NLM ISO Abbreviation: Prog Urol Subsets: MEDLINE

Publication: Paris : Progrès en urologie, S.A.R.L
Original Publication: Paris : F.I.I.S.,

Prostatic Hyperplasia/*surgery ; Urinary Bladder Neck Obstruction/*surgery ; Urologic Surgical Procedures, Male/*standards ; Urologic Surgical Procedures, Male/*trends; Humans ; Lower Urinary Tract Symptoms ; Male ; Prostatectomy/methods ; Prostatic Hyperplasia/complications ; Standard of Care ; Therapies, Investigational/methods ; Transurethral Resection of Prostate/methods ; Urinary Bladder Neck Obstruction/etiology ; Urologic Surgical Procedures, Male/methods

Introduction and Objective: Surgical management of benign prostatic hyperplasia has dramatically changed in the recent years towards higher proportion of endoscopic treatment and fewer perioperative complications. Nevertheless the question of urinary and sexual quality of life after surgical treatment remains partially unresolved with a high proportion of retrograde ejaculation after conventional surgical treatments. Therefore mini-invasive alternatives to conventional surgery have been proposed. The objective of this literature review was to provide an overview of the alternatives to monopolar TURP currently available in France.
Material and Method: A non-systematic review of the scientific literature was conducted from the PubMed database to retrieve the most relevant scientific publications. A first research was cross-referenced with the results of literature reviews already published and enriched by the authors of this review. A synthesis is proposed for each alternative technique mentioning its level of clinical development, but also its potential advantages and disadvantages compared to conventional surgical techniques.
Results: The quality of life of patients after surgical or interventional management has become the main priority of urologists since the risks of perioperative complication have been reduced by the use of laser or bipolar endoscopic techniques. Thanks to the development of minimally invasive alternatives that are better and better evaluated by randomized trials versus interventional simulation and conventional surgical treatment, more personalized care is possible. Patients' expectations and their individual risk factors can thus be placed at the center of the therapeutic decision and the preoperative information.
Conclusion: The surgical and interventional management of LUTS due to BPH has evolved to lower perioperative morbidity with the help of numerous technological developments. Mini-invasive alternatives to standard treatment have also been proposed in order to improve the quality of postoperative sexual life. These alternatives provide significant improvement in LUTS that remains lower than after conventional treatments. Somme of these alternative are also not fully supported by clinical trials, which should urge urologists to act with caution when proposing these alternatives in daily clinical practice.
(Copyright © 2018. Published by Elsevier Masson SAS.)

Keywords: Aquablation; Benign prostatic hyperplasia; Bipolaire; Bipolar; Embolisation prostatique; GreenLight; HBP; HoLEP; Laser; Prostatic arterial embolization; Rezum; TURP; Urolift

Date Created: 20181010 Date Completed: 20190213 Latest Revision: 20190215

20221213

10.1016/j.purol.2018.07.287

30297185