211:(FDA) in 1996, with the first generation system by EDAP Technomed. Since 1996, other companies have received FDA approval for TUMT devices, including Urologix, Dornier, Thermatrix, Celsion, and Prostalund. Multiple clinical studies have been published on TUMT. The general principle underlying all the devices is that a microwave antenna that resides in a urethral catheter is placed in the intraprostatic area of the urethra. The catheter is connected to a control box outside of the patient's body and is energized to emit microwave radiation into the prostate to heat the tissue and cause necrosis. It is a one-time treatment that takes approximately 30 minutes to 1 hour, depending on the system used. It takes approximately 4 to 6 weeks for the damaged tissue to be reabsorbed into the patient's body.
222:(TUNA) operates with a different type of energy, radio frequency (RF) energy, but is designed along the same premise as TUMT devices, that the heat the device generates will cause necrosis of the prostatic tissue and shrink the prostate. The TUNA device is inserted into the urethra using a rigid scope much like a cystoscope. The energy is delivered into the prostate using two needles that emerge from the sides of the device, through the urethral wall and into the prostate. The needle-based ablation devices are very effective at heating a localized area to a high enough temperature to cause necrosis. The treatment is typically performed in one session, but may require multiple sticks of the needles depending on the size of the prostate. The most recent
172:
the only prostate size-independent treatment option approved by the
American Urologic Association. HoLEP is largely similar to the HoLAP procedure; the main difference is that instead of ablating the tissue, the laser cuts a portion of the prostate, which is then cut into smaller pieces and flushed with irrigation fluid. As with the HoLAP procedure, there is little bleeding during or after the procedure. Three 2015 reviews found that HoLEP is superior to TURP in some respects and for some patients.
168:
falls within the infrared portion of the spectrum and is invisible to the naked eye. Whereas GreenLight relies on haemoglobin as a chromophore, water within the target tissue is the chromophore for
Holmium lasers. The penetration depth of Holmium lasers is <0.4 mm, avoiding complications associated with tissue necrosis often found with the deeper penetration and lower peak powers of Nd:YAG lasers used in the 1990s.
248:(marketed as Urolift) is a procedure for men with urinary symptoms caused by prostate enlargement. It consists of placing small hooks that compress the prostate tissue to open the urinary stream without cutting or removing tissue. This procedure likely improves quality of life without additional negative side effects when compared with a
29:
171:
Holmium Laser
Enucleation of the Prostate (HoLEP) is used to cut and remove the excess tissue that is blocking the urethra. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. HoLEP can be an option for men who have a severely enlarged prostate and is
309:
Any damage to the sphincter or surrounding muscles and nerves can lead to urinary incontinence. The problem is most severe in the first 6 to 12 months after treatment, but usually resolves on its own within this time. If the problem persists, conservative management is the first line treatment. This
652:
Cornu JN, Ahyai S, Bachmann A, de la
Rosette J, Gilling P, Gratzke C, et al. (June 2015). "A Systematic Review and Meta-analysis of Functional Outcomes and Complications Following Transurethral Procedures for Lower Urinary Tract Symptoms Resulting from Benign Prostatic Obstruction: An Update".
432:
to measure the pressure of urinary flow. By applying this methode, a study of 2013 showed that 94% of the patients with the pre-surgery test result "Obstruction" had a successful surgery outcome. In contrast, 70% of the patients with the pre-surgery test result "No
Obstruction" had a non-successful
167:
Holmium Laser
Ablation of the Prostate (HoLAP) is similar to PVP but uses a different type of laser. HoLAP uses a 550 um disposable side-firing fiber that directs the beam from a high-power 100-watt laser at a 70-degree angle from the fiber axis. The holmium wavelength is 2,140 nm, which
436:
If BPH with obstruction additionally presents with overactive bladder (OAB), which is the case in about 50% of patients, this latter symptom (OAB) persists even post-surgery in about 20% of patients. However, this rate only applies to a period of a few years. 10β15 years after surgery 48 of 55
155:
Photoselective
Vaporisation of the Prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel. A high-power 180-watt 532 nm wavelength laser with a 650-micrometre laser fiber is used. This fiber has an internal reflection with a 70-degree
445:
The UNBLOCS trial compared using transurethral resection of the prostate (TURP) to the thulium laser transurethral vaporesection of the prostate (ThuVARP). Both methods led to similar improvements, number of complications and lengths of hospital stay. Both were effective as treatment but TURP
120:
side-effects. These include various methods to destroy or remove part of the excess tissue while trying to avoid damaging what remains. Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), ethanol injection, and others are studied as alternatives.
119:
Efforts to find newer surgical methods have resulted in newer approaches and different types of energies being used to treat the enlarged gland. However some of the newer methods for reducing the size of an enlarged prostate, have not been around long enough to fully establish their safety or
140:
Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by prostate enlargement. The surgeon inserts a scope through the penis tip into the urethra. A laser passed through the scope delivers energy to shrink or remove excess tissue that is preventing urine flow.
467:
Lebdai S, Chevrot A, Doizi S, Pradere B, Delongchamps NB, Benchikh A, et al. (February 2019). "Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment".
237:(marketed as Rezum) is a newer office procedure for removing prostate tissue using steam. Several studies including a four-year follow-up provided evidence for improvement of BPH symptoms, preserved sexual function, and low surgical retreatment rates.
70:: In general prior to emergence of laser technologies, TURP had been considered the gold standard of prostate interventions for people who require a procedure. This involves removing (part of) the prostate by inserting a resectoscope (
195:
These procedures are typically performed with local anesthesia, and the patient returns home the same day. Some urologists have studied and published long-term data on the outcomes of these procedures, with data out to five years.
1465:
Malde S, Nambiar AK, Umbach R, Lam TB, Bach T, Bachmann A, et al. (March 2017). "Systematic Review of the
Performance of Noninvasive Tests in Diagnosing Bladder Outlet Obstruction in Men with Lower Urinary Tract Symptoms".
1366:
259:, the standard surgery for treating benign prostatic hyperplasia, this procedure may be less effective in reducing urinary symptoms but may preserve ejaculation and have fewer unwanted effects on erections.
562:
Helfand B, Mouli S, Dedhia R, McVary KT (December 2006). "Management of lower urinary tract symptoms secondary to benign prostatic hyperplasia with open prostatectomy: results of a contemporary series".
274:(AUA) guidelines for the treatment of BPH from 2018 list minimally invasive therapies including TUMT - but not TUNA - as acceptable alternatives for certain patients with BPH. However, the
267:
Temporary implantable nitinol device (marketed as TIND and iTIND) is a device that is placed in the urethra that, when released, is expanded, reshaping the urethra and the bladder neck.
420:
If BOO is present or not can be determined by reliable non-invasive tests, such as the Penile cuff test (PCT). In this test, first published in 1997, a software-steered inflatable
1394:
1378:
1362:
1297:
355:
78:. However, after this endoscopic surgery the ejaculations are dry in about 65% of patients, unless a novel, ejaculation preserving, altered technique of TURP is applied.
109:
409:(LUTS) β strongly depends on a reliable (unequivocal) pre-surgery diagnosis of bladder outlet obstruction (BOO). A pre-surgery diagnosis of other LUTS only, such as
437:
patients (87%) with obstruction and OAB had kept their post-surgery reduction of obstruction, but their OAB symptoms had gone back to the pre-surgery status.
128:
Minimally invasive therapies can offer faster recovery compared with traditional prostate surgery. They can further be divided into laser surgery (requiring
1273:
1382:
100:(TURP): the standard monopolar and the newer bipolar procedure. A 2019 Cochrane review of 59 studies that included 8924 men with urinary symptoms due to
1654:
1316:"The Urolift System for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance"
256:
97:
67:
1416:"Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence"
937:"Water vapor thermal therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia: Systematic review and meta-analysis"
600:"Bipolar versus monopolar transurethral resection of the prostate for lower urinary tract symptoms secondary to benign prostatic obstruction"
204:
1690:"Thulium laser transurethral vaporesection versus transurethral resection of the prostate for benign prostatic obstruction: the UNBLOCS RCT"
1100:
104:. This review found that bipolar and monopolar TURP probably results in comparable improvements in urinary symptoms, as well as a similar
390:
275:
271:
223:
1035:
717:"Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline Amendment 2020"
1748:
1743:
598:
Alexander CE, Scullion MM, Omar MI, Yuan Y, Mamoulakis C, N'Dow JM, et al. (Cochrane
Urology Group) (December 2019).
219:
1611:
Thomas AW, Abrams P (May 2000). "Lower urinary tract symptoms, benign prostatic obstruction and the overactive bladder".
987:
Jung JH, Reddy B, McCutcheon KA, Borofsky M, Narayan V, Kim MH, Dahm P, et al. (Cochrane
Urology Group) (May 2019).
226:(AUA) Guidelines for the Treatment of BPH from 2018 stated that "TUNA is not recommended for the treatment of LUTS/BPH".
703:
406:
319:
234:
208:
101:
52:
1398:
1301:
989:"Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia"
687:
156:
deflecting angle. It is used to vaporize the tissue to the prostatic capsule. GreenLight 532 nm lasers target
108:, the incidence of urinary incontinence, and the need for retreatment. Bipolar surgery likely reduces the risk of
853:"Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline"
378:
892:
Doppalapudi SK, Gupta N (January 2021). "What Is New with RezΕ«m Water Vapor Thermal Therapy for LUTS/BPH?".
245:
322:
implantation is considered the gold standard in moderate to severe cases if conservative management fails.
89:
1367:
Transurethral water jet ablation for lower urinary tract symptoms caused by benign prostatic hyperplasia
84:
can also be offered to men who have large prostates (>50 grams). This can be done by open technique,
176:
Both wavelengths, GreenLight and Holmium, ablate approximately one to two grams of tissue per minute.
935:
Miller LE, Chughtai B, McVary K, Gonzalez RR, Rojanasarot S, DeRouen K, Bhattacharyya S (July 2020).
414:
330:
298:
287:
373:
306:
302:
291:
1670:
1636:
1542:
917:
493:
410:
129:
1719:
1628:
1593:
1534:
1493:
1447:
1345:
1255:
1204:
1155:
1082:
1018:
966:
909:
874:
830:
789:
738:
670:
629:
580:
544:
485:
113:
105:
1688:
Worthington J, Lane JA, Taylor H, Young G, Noble SM, Abrams P, et al. (September 2020).
1709:
1701:
1662:
1620:
1583:
1573:
1524:
1483:
1475:
1437:
1427:
1335:
1327:
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1235:
1194:
1186:
1145:
1137:
1072:
1064:
1008:
1000:
956:
948:
901:
864:
851:
Foster HE, Barry MJ, Dahm P, Gandhi MC, Kaplan SA, Kohler TS, et al. (September 2018).
820:
779:
769:
728:
662:
619:
611:
572:
534:
524:
477:
425:
315:
447:
184:
1714:
1689:
1624:
1588:
1561:
1442:
1415:
1340:
1315:
1250:
1223:
1199:
1174:
1150:
1125:
1077:
1052:
1013:
988:
961:
936:
825:
808:
784:
757:
624:
599:
539:
512:
342:
334:
311:
180:
1661:(Plain English summary). National Institute for Health and Care Research. 2021-02-17.
1513:"Non-invasive urodynamics predicts outcome prior to surgery for prostatic obstruction"
1737:
1674:
1105:
Urinary Incontinence Education | Bladder Health | National Association for Continence
921:
326:
81:
1640:
1546:
497:
1655:"Laser surgery for an enlarged prostate is no more effective than standard surgery"
1190:
1173:
Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CM (January 2015).
1141:
1124:
Anderson CA, Omar MI, Campbell SE, Hunter KF, Cody JD, Glazener CM (January 2015).
1004:
809:"HoLEP: the gold standard for the surgical management of BPH in the 21(st) Century"
615:
249:
149:
774:
1479:
666:
164:
and typically have a penetration depth of 0.8 mm (twice as deep as holmium).
952:
733:
716:
161:
157:
85:
905:
869:
852:
576:
513:"Holmium laser enucleation of the prostate: patient selection and perspectives"
1331:
481:
338:
71:
1051:
Michaelson MD, Cotter SE, Gargollo PC, Zietman AL, Dahl DM, Smith MR (2008).
1432:
1240:
51:
If medical treatment is not effective, surgery may need to be performed for
1723:
1632:
1597:
1538:
1497:
1451:
1349:
1259:
1208:
1159:
1086:
1022:
970:
913:
878:
834:
793:
742:
674:
633:
584:
548:
489:
1101:"Urinary Incontinence After Prostate Surgery: Everything You Need To Know"
41:
1068:
278:(EAU) has - as of 2019 - removed both TUMT and TUNA from its guidelines.
1666:
1578:
1488:
529:
367:
305:. The prostate is located right beneath the bladder, and surrounds the
75:
1529:
1512:
1705:
148:
Visual laser ablation of the prostate (VLAP) technique involving the
1314:
Ray A, Morgan H, Wilkes A, Carter K, Carolan-Rees G (October 2016).
1175:"Conservative management for postprostatectomy urinary incontinence"
1126:"Conservative management for postprostatectomy urinary incontinence"
358:(NICE) of the UK in 2018 classified some novel methods as follows.
294:. The type of complications depend on the treatment modality used:
715:
Parsons JK, Dahm P, KΓΆhler TS, Lerner LB, Wilt TJ (October 2020).
429:
1038:
Management of Non-neurogenic Male LUTS - Summary of Changes 2019
421:
758:"Recent advances in treatment for Benign Prostatic Hyperplasia"
28:
187:
to permit healing and allow urine to drain from the bladder.
1053:"Management of complications of prostate cancer treatment"
286:
The two most feared complications of prostate surgery are
63:
There are two invasive surgical procedures done for BPH:
1369:, Interventional procedures guidance, 19 September 2018.
1401:, issue "Minimally invasive treatments", August 2018.
813:
American Journal of Clinical and Experimental Urology
207:(TUMT) was originally approved by the United States
144:Different types of prostate laser surgery include:
21:
1562:"Review of the epidemiology of overactive bladder"
405:(BPH) β as measured by a significant reduction of
1395:National Institute for Health and Care Excellence
1379:National Institute for Health and Care Excellence
1363:National Institute for Health and Care Excellence
1298:National Institute for Health and Care Excellence
356:National Institute for Health and Care Excellence
179:Post-surgical care often involves placement of a
1409:
1407:
1383:Rezum for treating benign prostatic hyperplasia
846:
844:
1385:, Medtech innovation briefing, 24 August 2018.
647:
645:
643:
301:can happen after prostate surgery, especially
68:Transurethral resection of the prostate (TURP)
33:Transurethral resection of the prostate (TURP)
1420:Ci Ji Yi Xue Za Zhi = Tzu-Chi Medical Journal
511:Marien T, Kadihasanoglu M, Miller NL (2016).
417:predicts little or no success after surgery.
8:
1274:"Erectile Dysfunction After Prostate Cancer"
1511:Losco G, Keedle L, King Q (November 2013).
1179:The Cochrane Database of Systematic Reviews
1130:The Cochrane Database of Systematic Reviews
993:The Cochrane Database of Systematic Reviews
604:The Cochrane Database of Systematic Reviews
1320:Applied Health Economics and Health Policy
27:
1713:
1587:
1577:
1528:
1487:
1441:
1431:
1339:
1249:
1239:
1224:"Management of male urinary incontinence"
1198:
1149:
1076:
1012:
960:
868:
824:
783:
773:
732:
623:
538:
528:
403:surgery for benign prostatic hyperplasia
391:High-intensity focused ultrasound (HIFU)
22:Surgery for benign prostatic hyperplasia
704:"Prostate laser surgery" mayoclinic.org
699:
697:
695:
459:
333:. Treatment options include the use of
257:transurethral resection of the prostate
98:transurethral resection of the prostate
18:
982:
980:
205:Transurethral microwave thermotherapy
200:Transurethral microwave thermotherapy
152:with contact on the prostatic tissue.
7:
571:(6 Pt 1): 2557β61, discussion 2561.
397:General prospects of surgery success
263:Temporary implantable nitinol device
1619:(Suppl 3): 57β68, discussion 70β1.
807:Michalak J, Tzou D, Funk J (2015).
37:
1625:10.1111/j.1464-410X.2000.tb16953.x
325:About 50% of patients who undergo
310:includes lifestyle modifications,
132:) and other non-laser procedures.
14:
1222:Moore KC, Lucas MG (April 2010).
688:"Laser PVP surgery" mayocilic.org
282:Complications of Prostate Surgery
1566:Research and Reports in Urology
517:Research and Reports in Urology
276:European Association of Urology
272:American Urological Association
224:American Urological Association
1560:Eapen RS, Radomski SB (2016).
1399:Current care pathway (for BPH)
1302:Current care pathway (for BPH)
1191:10.1002/14651858.CD001843.pub5
1142:10.1002/14651858.cd001843.pub5
1005:10.1002/14651858.CD012832.pub2
616:10.1002/14651858.CD009629.pub4
1:
775:10.12688/f1000research.7063.1
756:van Rij S, Gilling P (2015).
220:Transurethral needle ablation
215:Transurethral needle ablation
1694:Health Technology Assessment
1480:10.1016/j.eururo.2016.09.026
667:10.1016/j.eururo.2014.06.017
407:lower urinary tract symptoms
320:Artificial urinary sphincter
235:Water vapour thermal therapy
209:Food and Drug Administration
124:Minimally invasive therapies
102:benign prostatic hyperplasia
53:benign prostatic hyperplasia
953:10.1097/MD.0000000000021365
734:10.1097/JU.0000000000001298
303:stress urinary incontinence
292:stress urinary incontinence
230:Water vapor thermal therapy
1765:
906:10.1007/s11934-020-01018-6
870:10.1016/j.juro.2018.05.048
577:10.1016/j.juro.2006.07.143
1414:Jiang YH, Kuo HC (2017).
1332:10.1007/s40258-015-0218-x
1228:Indian Journal of Urology
482:10.1007/s00345-018-2368-6
329:will have some degree of
38:
26:
470:World Journal of Urology
379:Prostate steam treatment
1433:10.4103/tcmj.tcmj_19_17
1278:www.hopkinsmedicine.org
1241:10.4103/0970-1591.65398
894:Current Urology Reports
428:) is placed around the
246:Prostatic urethral lift
241:Prostatic urethral lift
96:There are two types of
857:The Journal of Urology
721:The Journal of Urology
565:The Journal of Urology
413:(OAB) with or without
136:Prostate laser surgery
446:resulted in a better
1749:Male genital surgery
1744:Prostatic procedures
1069:10.3322/CA.2008.0002
426:blood pressure meter
415:urinary incontinence
331:erectile dysfunction
299:Urinary incontinence
288:erectile dysfunction
191:Non-laser treatments
82:Simple prostatectomy
1667:10.3310/alert_44637
1579:10.2147/RRU.S102441
530:10.2147/RRU.S100245
374:Aquablation therapy
307:urethral sphincter.
1523:(Suppl 2): 61β64.
1280:. 19 November 2019
411:overactive bladder
90:robotic assistance
59:Invasive therapies
1613:BJU International
1530:10.1111/bju.12382
1517:BJU International
448:urinary flow rate
433:surgery outcome.
424:(similar as in a
130:spinal anesthesia
114:blood transfusion
112:and the need for
106:erectile function
49:
48:
1756:
1728:
1727:
1717:
1706:10.3310/hta24410
1685:
1679:
1678:
1651:
1645:
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1608:
1602:
1601:
1591:
1581:
1557:
1551:
1550:
1532:
1508:
1502:
1501:
1491:
1468:European Urology
1462:
1456:
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1411:
1402:
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1360:
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1170:
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1153:
1121:
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1111:
1097:
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1016:
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787:
777:
753:
747:
746:
736:
712:
706:
701:
690:
685:
679:
678:
661:(6): 1066β1096.
655:European Urology
649:
638:
637:
627:
610:(12): CD009629.
595:
589:
588:
559:
553:
552:
542:
532:
508:
502:
501:
464:
385:Not recommended:
316:bladder training
86:laparoscopically
42:edit on Wikidata
31:
19:
1764:
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1308:
1296:
1292:
1283:
1281:
1272:
1271:
1267:
1221:
1220:
1216:
1185:(1): CD001843.
1172:
1171:
1167:
1136:(1): CD001843.
1123:
1122:
1118:
1109:
1107:
1099:
1098:
1094:
1050:
1049:
1045:
1034:
1030:
999:(5): CD012832.
986:
985:
978:
934:
933:
929:
891:
890:
886:
850:
849:
842:
806:
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597:
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561:
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556:
510:
509:
505:
466:
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461:
456:
443:
401:The success of
399:
352:
312:kegel exercises
284:
265:
243:
232:
217:
202:
193:
185:prostatic stent
183:or a temporary
138:
126:
61:
45:
34:
17:
16:Type of surgery
12:
11:
5:
1762:
1760:
1752:
1751:
1746:
1736:
1735:
1730:
1729:
1680:
1646:
1603:
1552:
1503:
1474:(3): 391β402.
1457:
1403:
1387:
1371:
1355:
1326:(5): 515β526.
1306:
1304:, August 2018.
1290:
1265:
1234:(2): 236β244.
1214:
1165:
1116:
1092:
1063:(4): 196β213.
1043:
1028:
976:
947:(30): e21365.
927:
884:
863:(3): 612β619.
840:
799:
748:
727:(4): 799β804.
707:
691:
680:
639:
590:
554:
503:
476:(2): 299β308.
458:
457:
455:
452:
442:
439:
398:
395:
394:
393:
382:
381:
376:
371:
351:
348:
347:
346:
343:penile implant
339:vacuum devices
323:
283:
280:
264:
261:
255:Compared with
242:
239:
231:
228:
216:
213:
201:
198:
192:
189:
181:Foley catheter
174:
173:
169:
165:
153:
137:
134:
125:
122:
94:
93:
79:
74:) through the
60:
57:
47:
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