Abstract

To compare the safety and efficacy of transurethral plasmakinetic resection of the prostate (PKRP) versus transvesical prostatectomy (TVP) in the treatment of large-volume benign prostatic hyperplasia (LV-BPH) (100–149 mL). Ninety-nine BPH patients who had a prostate volume of 100–149 mL were divided into two groups to undergo PKRP or TVP. Preoperative clinical data were analyzed. Patients had follow-up appointments at 1 month, 3 months, 6 months, and 12 months postoperatively. Outcome measures included the International Prostate Symptom Score, quality of life score, maximum urinary flow rate, and postvoid residual urine volume. Adverse effects were also recorded. A total of 96 patients completed the 12-month follow-up. The operative time was longer, but intraoperative blood loss was lower in the PKRP group. Despite a higher percentage of patients requiring a blood transfusion, there was an obvious advantage in gland removal rate in the TVP group. The duration of postoperative catheterization, bladder irrigation, and hospital stay was significantly shorter in the PKRP group. Outcome measures were significantly improved in both groups 1 month postoperatively. The improvement in lower urinary tract symptoms was maintained throughout the 12 months after surgery. There were no significant differences in International Prostate Symptom Score, quality of life, maximum urinary flow rate, and postvoid residual urine volume between the two groups. PKRP has the advantage over TVP of being minimally invasive in the treatment of LV-BPH while achieving the same postoperative outcomes.

Abstract

To compare the efficacy and reliability of Ho:YAG laser lithotripsy (HLL) and pneumatic lithotripsy (PL) in the treatment of bladder stones in patients with benign prostatic hyperplasia and stones ≥ 20 mm who were transurethrally treated in the same surgical session. We studied the data of patients with benign prostatic hyperplasia and ≥20 mm bladder stones who were treated with transurethral resection of the prostate and cystolithotripsy in the same session, obtained between January 2010 and February 2014 from three urology clinics. All patients underwent bipolar plasmakinetic (PK) transurethral resection of the prostate. For treatment of the bladder stone, either HLL or PL was applied. A total of 62 patients were divided into two groups: PK-PL (Group 1, n = 29) and PK-HLL (Group 2, n = 33). The data of both groups were analyzed for stone dimensions, stone fragmentation time, total operating time, hospitalization duration, prostate dimensions, success rates, and complications. Group 1 included 29 patients with a mean age of 70 ± 7.6 (range, 57–85) years, whereas Group 2 included 33 patients with a mean age of 67.5 ± 10.5 (range, 45–84) years. In Group 1, five patients had mucosa injury, one patient had residual stone, and one patient had bladder perforation. In Group 2, three patients had mucosa injury, three patients had postoperative fever, and one patient had residual stone. Total operation time and stone fragmentation time were significantly lower in Group 2 (p < 0.05). The remaining analyzed data were similar (p > 0.05). PK-HLL using a single shaft without the need for repeated access has the advantages of shorter fragmentation and operation time.

Abstract

Etiology and pathophysiology of chronic internal disease was unknown until last days. This article challenges that two clinical trials have discovered the origin of chronic prostate diseases. The hypothesis of the chronic internal diseases cause due to pathological activity of capillaries with emerging micro-focus of hypothermia, a continuous trigger for disease development in any affected organ, was declared in the US patent “Therapeutic Device and Method”, i.e. thermobalancing therapy (TT) and therapeutic device. Two clinical trials before and 6 months after TT for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and benign prostatic hyperplasia (BPH) with the device, namely Dr. Allens therapeutic device (DATD) confirmed the effectiveness of TT. This device was used as mono-therapy for 124 patients with BPH and 45 men with CP/CPPS. Compared to controls, the TT groups showed significant improvements from baseline to endpoint. TT in men with BPH decreased urinary symptoms and PV, increased Qmax and improved quality of life index (QoL). At the same time, another clinical trial on TT in men with CP/CPPS has demonstrated decrease of pain score and PV mL, improvement of QoL and increase of Qmax mL/sec. The long-term application of the source of emitted body heat with DATD, i.e. TT, to the projection of affected prostate removes “micro-focus” of hypothermia at the capillary level that improves blood circulation in the organ and its function. Thus this article shows that the underlying cause for different chronic internal diseases, such as BPH and CP/CPPS is the same and is positioned at the microvascular level. More studies with thermobalancing therapy needed.