Laparoscopic simple prostatectomy vs bipolar plasma enucleation of the prostate in large benign prostatic hyperplasia: a two-center 3-year comparison.

PURPOSE: To compare surgery outcomes and safety of button bipolar enucleation of the prostate vs laparoscopic simple prostatectomy in patients with large prostates (> 80 g) in a two-center cohort study. METHODS: All patients with lower urinary tract symptoms due to benign prostatic enlargement (Prostate volume > 80 cc) undergoing button bipolar enucleation of the prostate (BTUEP) or laparoscopic simple prostatectomy (LSP) in two centers were enrolled. Data on clinical history, physical examination, urinary symptoms, uroflowmetry and prostate volume were collected at 0, 1, 3 6, 12, 24 and 36 months. Early and long-term complications were recorded. RESULTS: Overall, 296 patients were enrolled. Out of them, 167/296 (56%) performed a LSP and 129/296 (44%) performed a BTUEP. In terms of efficacy both procedures showed durable results at three years with a reintervention rate of 8% in the LSP group and of 5% in the BTUEP group. In terms of safety, BTUEP and LSP presented similar safety profiles with a 9% of transfusion rate and no major complications. CONCLUSION: LSP and BTUEP are safe and effective in treating large-volume adenomas with durable results at three years when performed in experienced centers.

Síndrome de déficit de testosterona en el anciano / Testosterone deficit syndrome in the old male

Los estudios epidemiológicos han demostrado que la prevalencia de hipogonadismo en los hombres de edad avanzada aumenta con cada década adicional de vida. Estos hombres presentan diversos síntomas que incluyen la disminución de la función sexual, disminución de la función cognitiva, perfil lipídico alterado, aumento de la adiposidad visceral, cambios en la densidad ósea y en la fuerza muscular secundaria a la atrofia. En la actualidad, las inyecciones de testosterona y preparaciones en forma de gel son las más usadas. La terapia de reemplazo de testosterona proporciona mejoras significativas en los síntomas para hombres con hipogonadismo de inicio tardío. Los beneficios a largo plazo y los riesgos del tratamiento con testosterona de reemplazo se harán más evidentes cuando los efectos de la testosterona se estudian en todos los parámetros relacionados con la salud durante un período prolongado de tiempo. Está en curso un gran ensayo multicéntrico aleatorizado patrocinado por NIH para el control de la testosterona en hombres de edad avanzada con niveles bajos de testosterona. Sus resultados pueden dar respuestas a los posibles beneficios y riesgos de reemplazo de testosterona en los hombres que envejecen. Si se produce un envejecimiento masculino se diagnostica como hipogonadismo de inicio tardío, el urólogo debe consensuar con el paciente los beneficios y riesgos potenciales de la terapia con testosterona (AU)

Los hombres ancianos que tienen eritrocitosis significativa, apnea del sueño no tratada, cáncer de próstata, y alto riesgo de eventos cardiovasculares deben ser excluidos de la terapia de reemplazo de testosterona. En la actualidad, no hay pruebas suficientes para afirmar claramente que los beneficios de la terapia de reemplazo de testosterona es mejor que los riesgos de este tratamiento de reemplazo en los hombres que envejecen. No se puede hacer una recomendación generalizada de que esta terapia de reemplazo de testosterona puede ser aplicada a todos los varones ancianos con niveles bajos de testosterona independientes de los signos o síntomas significativos (AU)

Epidemiological studies have demonstrated that prevalence of hypogonadism in old males increases with every additional decade of life. These males present various symptoms including decrease of sexual function, decrease of cognitive function, altered lipid profile, increased visceral adiposity, changes in bone density and muscular strength secondary to atrophy. Currently, testosterone injections and gel preparations are the most used. Testosterone replacement therapy provides significant symptomatic improvements for men with late start hypogonadism. Long-term benefits and risks of testosterone replacement therapy will be more evident when testosterone effects are studied on all health related parameters over a prolonged period of time. There is a large ongoing multicentric randomized clinical trial sponsored by NIH for testosterone control in old men with low testosterone levels. Its results may give answers to the possible benefits and risks of testosterone replacement in aging males. If an aging male is diagnosed as late-start hypogonadism, the urologist should discuss with the patient potential benefits and risks of testosterone therapy. Aging males with significant erythrocytosis, untreated sleep apnea, prostate cancer and high risk of cardiovascular events must be excluded from testosterone replacement therapy. Currently, there are not enough evidences to clearly state that the benefits of testosterone replacement therapy in aging males are better than the risks of this treatment. A general recommendation cannot be given that testosterone replacement therapy may be applied to al aging males with low testosterone levels independently of significant signs or symptoms (AU)