ABSTRACT
Benign prostatic hyperplasia (BPH) is the most common benign adenoma in men, affecting nearly all of them. BPH represents a clinically significant cause of bladder outflow obstruction in up to 40% of men. The growing frequency of diagnosis is due to increasing life expectancy and a trend toward seeking medical advice at earlier stages of the disease. The last decade has witnessed a significant shift in emphasis in the management of BPH, with medical therapies and, to a lesser extent, minimally invasive therapies becoming the predominant active therapy choices. The development of effective therapies such as alpha-adrenergic blockers and 5-alpha-reductase inhibitors and the possibility of their combined use represent the most significant advance in the treatment of BPH.
Subject(s)
Prostatic Hyperplasia/therapy , 5-alpha Reductase Inhibitors/therapeutic use , Adrenergic alpha-Antagonists/therapeutic use , Cholinergic Antagonists/therapeutic use , Dihydrotestosterone/metabolism , Disease Progression , Humans , Male , Primary Health Care , Randomized Controlled Trials as Topic , Surveys and Questionnaires , Testosterone/metabolism , Watchful WaitingABSTRACT
BACKGROUND: Transurethral resection of the prostate (TURP) has been the gold standard of the treatment of benign prostatic hyperplasia (BPH). In recent years there has been a significant shift in the treatment of BPH and guidelines emphasize minimally invasive surgery as a new treatment option. Minimal invasive technologies (MITs), such as transurethral microwave thermotherapy (TUMT), laser ablations, transurethral needle ablation (TUNA) have emerged as an alternative to the TURP. OBJECTIVES: To assess the retreatment rates of the most commonly used minimal invasive techniques. SEARCH STRATEGY: Durability articles were selected by using defined search terms using PubMed as search engine. RESULTS: Comparing to the overall retreatment rates of MITs the results show that TUMT, holmium laser enucleation of the prostate (HoLEP) and contact laser vaporization (CLV) are among the treatments with the lowest retreatment rates. Studies show no significant differences in retreatment rates between TUMT and TURP. CONCLUSION: A review of the current literature, long term results and retreatment rates of MITs shows large variability in outcomes and retreatment rates. The true definition of a MIT remains unclear. High energy TUMT deserves reconsideration in clinical practices, due to low retreatment rates and the low need of anesthetics.