Treatment of beneficial prostate hyperplasia of large sizes: traditional surgical, low-invasive and laser technologies (literature review)

Benign prostatic hyperplasia – one of the most common diseases in older men. The treatment strategy for benign prostatic hyperplasia consists in its drug therapy, or active surgical tactics. The indication for planned surgical treatment of benign prostatic hyperplasia is the progression of symptoms of the lower urinary tract, which are not amenable to drug correction. Men with a large prostate volume of more than 80 m³, with severe symptoms of the lower urinary tract, with a history of acute urinary retention episodes, represent a difficult group of patients in terms of choosing the tactics of surgical treatment. This article discusses the most common operations that are used in the treatment of benign prostatic hyperplasia (especially of large sizes): open adenectomy, transurethral resection of the prostate gland, enucleation of benign prostatic hyperplasia using a holmium laser, embolization of an artery of the prostate gland. Surgical treatment of benign prostatic hyperplasia requires an individual approach to the patient, taking into account his age, concomitant pathology and clinical symptoms.

1. Egan K.B. The Epidemiology of Benign Prostatic Hyperplasia Associated with Lower Urinary Tract Symptoms: Prevalence and Incident Rates. Urol Clin North Am. 2016; 43 (3): 289– 297. doi:10.1016/j.ucl.2016.04.001

2. Roytberg G.E., Usychkin S.V., Boiko A.V. Extreme hypofractionated external-beam radiotherapy for prostate cancer. Medicinskaya radiologiya i radiacionnaya bezopasnost. 2016; 61 (1): 47–59. [In Russ.].

3. Marmiroli R., Antunes A.A., Reis S.T., Nakano E., Srougi M. Standard surgical treatment for benign prostatic hyperplasia is safe for patients over 75 years: analysis of 100 cases from a high-volume urologic center. Clinics (Sao Paulo). 2012; 67 (12): 1415–1418. doi:10.6061/clinics/2012(12)11

4. Kulchenko N.G., Yatsenko E.V. The role of anti-inflammatory therapy in the treatment of acute and chronic prostatitis. Features of innovative Ketoprofen molecule. Literature review. Experimental and clinical urology 2019; (3): 158–163. [In Russ.]. doi:10.29188/2222-8543-2019-11-3-158-163

5. Kaprin A.D., Kostin A.A., Kulchenko N.G. Optimization of drug therapy for benign prostatic hyperplasia. Voprosy urologii i andrologii. 2013; 2 (1): 5–9. [In Russ.].

6. Kulchenko N.G. Optimizing the conservative therapy of benign prostatic hyperplasia by inhibitors of 5–alfareductase. Clinical and morphological study. Kursk Scientific and Practical Bulletin «Man and His Health». 2012; 1: 101–106. [In Russ.].

7. Gromov A.I., Builov V.M. Luchevaya diagnostika i terapiya v urologii [Radiation diagnostics and therapy in urology]. М.: GEOTAR-Media, 2011: 544. [In Russ.].

8. Roitberg G.E., Mkrtchyan K.G., Kulchenko N.G. Influence of chronic ischemic disorders in the prostate on the development of benign prostatic hyperplasia. Research and Practical Medicine Journal (Issled. prakt. med.). 2020; 7 (2): 75–81. [In Russ.]. doi:10.17709/2409-2231-2020-7-2-7

9. Petrillo M., Pesapane F., Fumarola E.M. et al. State of the art of prostatic arterial embolization for benign prostatic hyperplasia. Gland Surg. 2018;7 (2): 188–199. doi:10.21037/gs.2018.03.01

10. Kaprin A.D., Kostin A.A., Kulchenko N.G. A relationship between ultrasound and morphological changes of prostate tissue in patients with benign hyperplasia during medical therapy. Andrologiya i genitalnaya hirurgiya. 2012; 13 (3): 47–51. [In Russ.].

11. Rojtberg G.E., Kondratova N.V., Smirnova E.V. International standards requirements to medication safety. Quality management in medicine. 2018; (2): 75–79. [In Russ.].

12. Kulchenko N.G., Yatsenko E.V. Phytotherapy for inflammatory diseases of the prostate. Research and Practical Medicine Journal (Issled. prakt. med.). 2019; 6 (3): 87–97. [In Russ.]. doi:10.17709/2409-2231-2019-6-3-8

13. Rassweiler J., Teber D., Kuntz R. Complications of transurethral resection of the prostate (TURP) – incidence, management, and prevention. Eur Urol. 2006; 50: 969–979. doi:10.1016/j.eururo.2005.12.042

14. Filimonov V.B., Vasin R.V., Sobennikov I.S. Improving the quality of prostate transurethral resection in patients with benign prostatic hyperplasia through intraoperative transrectal ultrasound monitoring of the removed tissue volume. Research and Practical Medicine Journal. 2019; 6 (2): 51–57. [In Russ.]. doi:10.17709/2409-2231-2019-6-2-5

15. Mikhaleva L.M., Kulchenko N.G. Clinical and morphological characteristics of the prostate gland during treatment with alpha 1-blockers and 5-alpha reductase inhibitors for its nodular hyperplasia. Modern high technologies. 2010; 10: 63–66. [In Russ.].

16. McWilliams J.P., Kuo M.D., Rose S.C. et al. Society of interventional radiology position statement: prostate artery embolization for treatment of benign disease of the prostate. J. Vasc. Interv. Radiol. 2014; 25: 1349–1351. doi:10.1016/j.jvir.2014.05.005

17. Oelke M., Bachmann A., Descazeaud A. et al. Management of male lower urinary tract symptoms (LUTS), incl. benign prostatic obstruction (BPO). In European Association of Urology, European Association of Urology Guidelines 2012 ed, Arnhen: Drukkerij Gebler and bv, 2012: 1–73.

18. Rocco B., Albo G., Ferreira R.C. et al. Recent advances in the surgical treatment of benign prostatic hyperplasia. Ther Adv Urol. 2011; 3 (6): 263–272. doi:10.1177/1756287211426301

19. Varkarakis I., Kyriakakis Z., Delis A. et al. Long-term results of open transvesical prostatectomy from a contemporary series of patients. Urology. 2004; 64 (2): 306–310.

20. Serretta V., Morgia G., Fondacaro L. et al. Members of the Sicilian-Calabrian Society of Urology. Open prostatectomy for benign prostatic enlargement in southern Europe in the late 1990s: a contemporary series of 1800 interventions. Urology. 2002; 60 (4): 623–627. doi:10.1016/s0090-4295(02)01860-5

21. Welliver C., Helo S., McVary K.T. Technique considerations and complication management in transurethral resection of the prostate and photoselective vaporization of the prostate. Transl. Androl. Urol. 2017; 6 (4): 695–703. doi:10.21037/tau.2017.07.30

22. Issa M.M. Technological advances in transurethral resection of the prostate: bipolar versus monopolar TURP. J. Endourol. 2008; 22: 1587–1595.

23. Sоnksen J., Barber N.J., Speakman M.J. et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur. Urol. 2015; 68 (4): 643–652.

24. Mayer E.K., Kroeze S.G., Chopra S. et al. Examining the «gold standard»: a comparative critical analysis of three consecutive decades of monopolar transurethral resection of the prostate (TURP) outcomes. BJU Int. 2012; 110: 1595–1601.

25. Ahyai S.A., Gilling P., Kaplan S.A. et al. Meta-analysis of functional outcomes and complications following transurethral procedures for lower urinary tract symptoms resulting from benign prostatic enlargement. Eur. Urol. 2010; 58: 384–397.

26. Napal Lecumberri S., Insausti Gorbea I., Sáez de Ocáriz García A. et al. Prostatic artery embolization versus transurethral resection of the prostate in the treatment of benign prostatic hyperplasia: protocol for a non-inferiority clinical trial. Res. Rep. Urol. 2018; 10: 17–22. doi:10.2147/RRU.S139086

27. Elzayat E.A., Habib E.I., Elhilali M.M. Holmium laser enucleation of the prostate: a size-independent new «gold standard». Urology. 2005; 66 (5): 108–113.

28. Montorsi F., Naspro R., Salonia A. et al. Holmium laser enucleation versus transurethral resection of the prostate: results from a 2-center prospective randomized trial in patients with obstructive benign prostatic hyperplasia. J. Urol. 2008; 179 (5): 87–90.

29. Kuebker J.M., Miller N.L. Holmium Laser Enucleation of the Prostate: Patient Selection and Outcomes. Curr. Urol. Rep. 2017; 18 (12): 96. doi:10.1007/s11934-017-0746-z

30. Kuntz R.M., Lehrich K., Ahyai S.A. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur. Urol. 2008; 53: 160–166.

31. Kim M., Piao S., Lee H.E., Kim S.H., Oh S.J. Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia. Korean J. Urol. 2015; 56 (3): 218–226. doi:10.4111/kju.2015.56.3.218

32. Matlaga B.R., Kim S.C., Kuo R.L. et al. Holmium laser enucleation of the prostate for prostates of > 125 mL. BJU Int. 2006; 97 (1): 81–84. doi:10.1111/j.1464-410X.2006.05898.x

33. Ryoo H.S., Suh Y.S., Kim T.H. et al. Efficacy of Holmium Laser Enucleation of the Prostate Based on Patient Preoperative Characteristics. Int. Neurourol. J. 2015;19 (4): 278–285. doi:10.5213/inj.2015.19.4.278

34. Carnevale F.C., Soares G.R., de Assis A.M. et al. Anatomical Variants in Prostate Artery Embolization: A Pictorial Essay. Cardiovasc. Intervent. Radiol. 2017; 40: 1321–1337.

35. Pisco J.M., Bilhim T., Pinheiro L.C. et al. Medium- and LongTerm Outcome of Prostate Artery Embolization for Patients with Benign Prostatic Hyperplasia: Results in 630 Patients. J. Vasc. Interv. Radiol. 2016; 27: 1115–1122.

36. Bagla S., Smirniotopoulos J.B., Orlando J.C. et al. Comparative Analysis of Prostate Volume as a Predictor of Outcome in Prostate Artery Embolization. J. Vasc. Interv. Radiol. 2015; 26: 1832–1838.

37. Wang M.Q., Guo L.P., Zhang G.D. et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms due to large (>80 mL) benign prostatic hyperplasia: results of midterm follow-up from Chinese population. BMC Urol. 2015; 15: 33. doi:10.1186/s12894-015-0026-5

38. Gabr A.H., Gabr M.F., Elmohamady B.N. et al. Prostatic Artery Embolization: A Promising Technique in the Treatment of High-Risk Patients with Benign Prostatic Hyperplasia. Urol. Int. 2016; 97: 320–324.

39. Li Q., Duan F., Wang M.Q. et al. Prostatic Arterial Embolization with Small Sized Particles for the Treatment of Lower Urinary Tract Symptoms Due to Large Benign Prostatic Hyperplasia: Preliminary Results. Chin. Med. J. (Engl.). 2015; 128: 2072–2077.

40. Karpov V.K., Kapranov S.A., Shaparov B.M. et al. Superselective prostatic artery embolization for BPH treatment. Urologiya. 2019; 3: 134–141. [In Russ.]. doi:10.18565/urology.2019.3.134-141