Benign Prostate Syndrome: Diagnostics and Therapy of the BPS

Description

Benign prostate syndrome (BPS) affects more than half of all men over the age of 50. It is often suppressed for a long time, especially because the corresponding examinations are shied away from. Therapy is varied, and many treatment options have been added in recent years that can help improve symptoms. These options advertise themselves primarily as avoiding the dreaded side effects of surgery: Incontinence, impotence and loss of ejaculation.This book provides an overview of all currently available treatment options for BPH and targeted diagnostics. Under the leadership of the renowned editors, many experts have compiled their knowledge in this practical book. Differential diagnostics with imaging and urodynamics are explained, and the many ways of therapy from watchful waiting to drug therapy to surgery are discussed and the advantages and disadvantages pointed out. A separate chapter is devoted to prevention. In addition, myths that still prevail in many places as "expert opinion" are discussed.  A practical book for every urologist! Preface Contents Contributors 1 Epidemiology 1.1  Prevalence and Incidence of LUTS and BPS 1.2  Natural Course and Risks of Progression 1.3  BPS in Germany: Herne LUTS/BPS Study References 2 Anatomy of the Prostate 2.1  Introduction 2.2  Structure References 3 Pathophysiology 3.1  Introduction 3.2  Histology 3.3  Endocrinology 3.4  Concept of Age-Associated Tissue Remodeling 3.5  Lifestyle Factors 3.6  Metabolic Syndrome 3.7  Bladder Dysfunction References 4 Symptomatology 4.1  Complications and Late Effects 4.2  Classification of Benign Prosta te Syndrome 4.3  Symptom Scores References 5 Clinical Diagnostics 5.1  Medical History 5.2  Assessment of the Upper Urinary Tract 5.3  Physical Examination 5.4  Urinalysis 5.5  Prostate-Specific Antigen 5.6  Kidney Function Measurement 5.7  Optional Diagnostics References 6 Imaging Techniques for the Benign Prostate Syndrome 6.1  Introduction 6.2  Ultrasound 6.2.1  Kidney, Ureter and Retroperitoneum 6.2.2  Urinary Bladder 6.2.3  Prostate 6.3  Other Methods 6.3.1  X-ray 6.3.2  Magnetic Resonance Imaging References 7 Endoscopy 7.1  Indication 7.2  Cystoscopes 7.3  Procedure 7.4  Diagnostic Performance in BPH 7.5  Conclusions References 8 Uroflow and Residual Urine 8.1  Uroflowmetry 8.2  Residual Urine References 9 Urodynamics 9.1  Introduction 9.2  Procedure 9.3  Cystometry 9.4  Pressure-Flow Measurement 9.5  Other Examination Techniques References 10 Controlled Waiting 10.1  Principle 10.2  Indication 10.3  Risk Factors 10.4  Assessment References 11 Pharmacological Therapy 11.1  Phytopharmaceuticals 11.2  Alpha-Blockers 11.3  5-Alpha-Reductase Inhibitors 11.4  Phosphodiesterase Inhibitors 11.5  Antimuscarinics 11.6  Beta-3-Agonist Mirabegron 11.7  Combination Therapies References 12 Surgical Techniques: Basics 12.1  Surgical Basics 12.2  Surgical Principles: Vaporization, Enucleation, Resection 12.3  Lasers: Basic Knowledge 12.4  Lasers in the Treatment of Benign Prostatic Hyperplasia (BPH) 12.4.1  Holmium Laser 12.4.2  Thulium Laser 12.4.3  GreenLight Laser 12.4.4  Diode Lasers 12.4.5  ERASER Laser References 13 Ablative Procedures: Enucleation 13.1  Open Simple Prostatectomy (OSP) 13.1.1  Transvesical OSP (Freyer): Surgical Principle 13.1.2  Retropubic OSP (Millin): Surgical Principle 13.1.3  Outcomes of OSP 13.2  Laparoscopic Simple Prostatectomy (LSP) 13.3  Robot-Assisted Simple Prostatectomy (RASP) 13.3.1  RASP: Surgical Principle 13.3.2  Results on RASP 13.4  Transurethral Enucleation of the Prostate 13.4.1  Monopolar Enucleation of the Prostate (MEP) 13.4.2  Holmium Laser Enucleation of the Prostate (HoLEP) 13.4.3  HoLEP Surgical Technique 13.4.4  Results on HoLEP 13.4.5  Bipolar Enucleation of the Prostate (BipolEP) 13.4.6  ThuliumVapoEnucleation of the Prostate (ThuVEP) 13.4.7  Thulium Laser Enucleation of the Prostate (ThuLEP) 13.4.8  GreenLight Laser Enucleation of the Prostate (GreenLEP) 13.4.9  ERASER Laser Enucleation of the Prostate (ELEP) 13.4.10  Diode Laser Enucleation of the Prostate (DiLEP) 13.4.11  Photoselective VapoEnucleation of the Prostate (PVEP) 13.4.12  Thulium Fiber Laser Enucleation of the Prostate (ThuFLEP) 13.4.13  MOSES Laser Enucleation of the Prostate (MoLEP) 13.5  Conclusions References 14 Ablative Procedures: Resection 14.1  Introduction 14.2  Transurethral Resection of the Prostate (TUR-P) 14.2.1  Resection Technique TUR-P: Results 14.3  Ablative Procedures: Thulium VapoResection of the Prostate (ThuVARP) References 15 Ablative Procedures—Vaporization: Bipolar and Photoselective Vaporization of the Prostate 15.1  Bipolar Transurethral Vaporization of the Prostate 15.1.1  Mechanism of Action 15.1.2  Functional Results 15.1.3  Peri- and Postoperative Safety 15.2  Greenlight Laser Vaporization of the Prostate (PVP, Photoselective Vaporization of the Prostate) 15.2.1  Mechanism of Action 15.2.2  Functional Results 15.2.3  Peri- and Postoperative Safety 15.2.4  PVP in Patients with Increased Bleeding Risk 15.2.5  Data from Case Series 15.2.6  Impact of PVP on Sexual Function and Ejaculation-Preserving Techniques References 16 Ablative Procedures—Robotics 16.1  Procedure and Mechanism of Action 16.2  Functional Results 16.3  Peri- and Postoperative Safety 16.4  High Risk Patients References 17 Non-Ablative Procedures 17.1  Urolift® 17.1.1  Procedure and Mechanism of Action 17.1.2  Functional Results 17.1.3  Peri- and Postoperative Safety 17.2  Rezum® 17.2.1  Procedure and Mechanism of Action 17.2.2  Functional Results 17.2.3  Peri- and Postoperative Safety 17.3  iTind® 17.3.1  Procedure and Mechanism of Action 17.3.2  Functional Results 17.3.3  Peri- and Postoperative Safety 17.4  Prostatic Arterial Embolization (PAE) 17.4.1  Procedure and Mechanism of Action 17.4.2  Functional Results 17.4.3  Peri- and Postoperative Safety References 18 Economic Aspects of BPS 18.1  Life Expectancy 18.2  Cost Relevance of a Therapy 18.3  Costs of Lost Working Time 18.4  Costs due to Complications After Surgery 18.5  Overall View References 19 Patient Selection 19.1  Differential Diagnosis 19.1.1  Prostate Cancer 19.1.2  Prostatitis 19.1.3  Neurogenic Bladder Dysfunction 19.2  Factors Influencing the Indication 19.2.1  Age 19.2.2  Comorbidities 19.2.3  Patient`s Requests 19.3  Morbidity and Follow-Up Treatment Rate 19.3.1  Drug Side Effects 19.3.2  Consequences of Surgery 19.4  Individual Therapy between Expectations and Reality References 20 Guidelines 20.1  What is the Purpose of a Guideline? 20.2  Effectiveness and Quality of Guidelines 20.3  Criticism and Error-Proneness of Guidelines 20.4  Comparison of EAU, AUA and DGU Guidelines 20.4.1  Guidelines for the Diagnosis of BPS 20.4.2  Guidelines for the Drug Therapy of BPS 20.4.3  Guidelines for the Surgical Therapy of BPS 20.5  Summary References 21 Prevention of Benign Prostate Syndrome 21.1  Forms of Prevention 21.2  Primary Prevention 21.3  Secondary Prevention 21.4  Conclusions References 22 The Geriatric Patient 22.1  Introduction and Definitions 22.2  The Importance of Pre-Therapeutic Evaluation: The Geriatric Assessment 22.3  Specifics of the Pharmacological Therapy of BPS in the Geriatric Patient 22.4  Surgical Therapy in Geriatric Patients—Outcomes and Complications References 23 Controversies in Conservative and Surgical BPS Therapy 23.1  Does the Normal-Sized Prostate Correspond to A Chestnut, is it 20 g in Size? 23.2  Is there a Bladder Outlet Obstruction (BOO) in Case of a Large Prostate? 23.3  Are Bladder Trabeculae Composed of Hypertrophied Muscle and are they Signs of Bladder Outlet Obstruction (BOO)? 23.4  What are Bladder Diverticula and Bladder Pseudodiverticula? 23.5  Is Urethrocystoscopy Suitable for the Diagnosis of Bladder Outlet Obstruction (BOO)? 23.6  Does BPS Progress in Stages? 23.7  Is Residual Urine Formation Caused by Bladder Outlet Obstruction? 23.8  Does Residual Urine (RU) Lead to Urinary Tract Infections (UTIs)? 23.9  Does RU Lead to Urinary Retention? 23.10  Does RU Formation Lead to Renal Dysfunction? 23.11  Can Drugs Reduce Bladder Outlet Obstruction (BOO)? 23.12  “Transurethral Enucleation Procedures take too Long Time. For Open Simple Prostatectomy (OSP) I just need 40 min” 23.13  Is Resection to the Prostate Capsule Essential for an Optimal Result of TUR-P? 23.14  What is Meant by Long-Term Data in Surgical BPS Therapy? 23.15  Is a Histology Necessary After the Surgical Treatment of BPS? 23.16  Can I Perform a HoLEP with the Thulium Laser? 23.17  Are the Clinical (Long-Term) Data for GreenLight Vaporisation of the Prostate (PVP), Aquabeam®, iTind®, Rezum® and Urolift® convincing? 23.18  Is it Possible to Treat a 150-g Prostate by TUR-P? 23.19  Is the Learning Curve (LC) of (Laser) Enucleation of the Prostate Longer than that of TUR-P? 23.20  We Perform Robotic-Assisted Simple Prostatectomy (RASP) Because Patients are Incontinent and Bleed After Transurethral Enucleation 23.21  “The GreenLight Laser Is Not Suitable for BPS Surgery. Finally, You Have To Take the Loop.” Is a Surgical (Laser) Procedure for the Treatment of BPS Unreasonable, Because Finally One Takes a Loop for Coagulation? 23.22  We Perform Transurethral (Laser) Enucleation of the Prostate in Prostates larger than 60 g, Below that TUR-P Because of Training the Residents. We Perform Open Simple Prostatectomy Because of Training the Residents 23.23  Are more Patients Incontinent After Laser Surgery of the Prostate than After TUR-P? 23.24  Do Patients Develop more Urge Symptoms After Laser Surgery of the Prostate than After TUR-P and Open Simple Prostatectomy (OSP)? 23.25  Do have New-Minimally Invasive Procedures such as Aquabeam®, Rezum® or Urolift® No Serious Complications? References