| Abstrakt: |
The treatment of non-neurogenic lower urinary tract symptoms (LUTS) has changed significantly in recent years. This applies to both medical and surgical therapy options. Although surgical treatment of benign prostatic obstruction (BPO) is now used much less frequently than several decades ago, there is still a certain subset of patients who have absolute or relative indications for surgery. Traditionally, transurethral resection of the prostate (TURP) has been and remains the gold standard against which all newer minimally invasive surgical methods are compared. Although in recent decades new surgical methods based on various forms of energy have been introduced into practice with the aim of reducing the duration of the postoperative period, complications, and consequently the cost of surgery, only a small part of these methods have become widespread. The technique of TURP itself has also changed significantly with the introduction of bipolar TURP (B-TURP). Furthermore, B-TURP has made it possible to introduce a completely different technique of performing the operation - prostate enucleation. Its main advantage is the ability to completely remove the prostate regardless of its size, and studies show that this operation is safe and effective for any gland volume. Numerous comparative studies have shown that prostate enucleation likely reduces the frequency of TUR syndrome, blood transfusion, the frequency of repeat surgeries, and improves functional outcomes. This could make B-TURP prostate enucleation the new "gold standard" for endoscopic prostate surgery. Another important direction in prostate surgery is laser enucleation. It has been actively developing in recent years, and its share is constantly increasing. Laser enucleation makes it possible to radically transform the surgical technique, moving from cutting the prostate into pieces to the principle of anatomical enucleation, where the gland is removed as a single block. This technique has raised the safety and effectiveness of the operation to a new level, competing with classical prostatectomy. This has led to a reduction in hospital stay, the frequency of repeat surgeries, and a decrease in the risk of such a severe complication as vascular thrombosis. Thus, the introduction of new methods of surgical treatment for BPO allows for safer surgery, better functional outcomes, and treatment of complex patients for whom classical TURP is too risky. [ABSTRACT FROM AUTHOR] |
