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Increasing the number of quality prospective RCTs with adequate follow-up is mandatory to tailor each technique to the right patient. Statistical analysis included the Kaplan-Meier method and random-effects generalized least squares regression with autoregressive disturbance. A total of 3 studies were included, with a total sample size of subjects subjects in the experimental group and subjects in the control group. However, in a review on recent developments in the management of symptomatic BPH, Ogiste and colleagues stated that the role of stents as an intermediary in cases of treatment failure, or as definitive therapy for BPH and its associated problems are still unclear, when compared with newer, minimally invasive options. The authors concluded that the advantage of HoLEP over TURP is the very low bleeding rate and thus a shorter hospital stay and possible out-patient therapy. The cost of currently recommended medications and the discontinuation rate due to side effects are significant drawbacks limiting their long-term use in clinical practice. A meta-analysis after medium-term follow-up 12 to 18 weeks indicated no significant effect on IPSS when the data from 2 trials were combined MD Among surgical alternatives, holmium laser enucleation has gained ground as an encouraging new approach, being similar to standard transurethral resection of the prostate, but reducing perioperative morbidity with the same long-term results. There was no evidence of degradation in erectile or ejaculatory function after PUL. The effectiveness, including International Prostate Symptom Score, quality of life, benign prostatic hyperplasia Impact Index, and peak urethral flow rate were assessed at 2 weeks and 3, 6, 12, and 24 months. Gonadotropin-releasing hormone antagonists, intra-prostatic injections with NX and vitamin D3 receptor analogs exerted beneficial effects on LUTS but need further evaluation in clinical studies. Short-term voiding complaints were expressed by Diode laser through vaporization was the rapidest in removing post-operative indwelling catheter, while TURP was the longest. A total of 57 articles were identified, and 4 were selected for inclusion in this review.
Potential advantages of laser therapy over traditional TURP include decreased morbidity and shorter hospital stay. The extirpated adenomas were grossly examined followed by whole mount sectioning and staining with triphenyl-tetrazolium chloride TTC to evaluate thermal ablation. There was no instance of de-novo sustained anejaculation or ED over the course of the study. The use of bipolar energy in the endoscopic treatment of BPH presented a significant reduction in operative time, peri-operative complications, shorter catheterization time, reduced number of blood products transfused, and shorter hospital stay compared to standard techniques. However, clinical data from these procedures are in their infancy and large long-term studies are needed to ascertain their clinical effectiveness. There was no deterioration in erectile function according to the International Index of Erectile Function-5 short form. They stated that PAE may play an important role in patients in whom medical therapy has failed, and who are not candidates for surgery or TURP or refuse any surgical treatment. Those with moderate or severe BPH should be discouraged from alternative and complementary treatments. International Prostate Symptom Score decreased a mean of 6. The improvement was sustained to 24 months after treatment with no significant difference between the groups. Severe blood loss was more common following TURP. Clinical success was defined when symptoms and QOL were improved. Zhang et al stated that all available surgical treatments for BPH have their individual advantages or disadvantages. Further comparative studies are mandatory to assess post-operative rates of complications, especially acute urinary retention, after PAE and standard procedures. The re-operation rate within 12 months was 6. In both cases energy is transferred via a transurethral needle injection. Bipolar energy introduced the use of saline irrigation and laser technology increased the urological armamentarium to treat BPH. Recent pre-clinical studies on histotripsy were reviewed for treating BPH, liver and kidney tumors, kidney stone fragmentation, enhancing anti-tumor immune response, and tissue de-cellularization for regenerative medicine applications. Traditional surgical methods of open enucleation and TURP have been effective in alleviating these symptoms however, these are operator-dependent and often come with significant side effects. Although the results of the clinical studies are encouraging, the level of evidence is low. However, they stated that more large-scale and high quality head-to-head RCTs are needed to validate the conclusions. The incidence of severe or prolonged bleeding was less with TUVP, as evidenced by the need for blood transfusion and the drop in hemoglobin level 24 hours post-operatively. Histotripsy is a non-invasive, non-thermal, focused US therapy that mechanically liquefies targeted tissues within the body. A total of 36 studies involving 3, patients were included. Ablation using vapor was rapid and remained confined to the transition zone, consistent with the thermodynamic principles of convective thermal energy transfer.
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