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!

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Preface

Twenty years have passed since the last edition of the Springer textbook “Benign Prostatic Hyperplasia—A Guide for the Clinic and Practice” by the editorial team Klaus Höfner, Christian Stief & Udo Jonas.

Twenty years—two decades—represent half an eternity in science. A rough PubMed-based literature search with the search term “benign prostatic hyperplasia” and the input period 2000–2021 yielded 16,746 hits on May 18, 2021, 10 pm! But not only scientifically a lot has happened. While the editorial team was still studying (pre-clinic: C. Netsch) or looking for a chief physician position (senior physician: A. J. Gross) at that time, the reading and working habits in the medical field have also changed fundamentally in the two decades due to the triumph of the World Wide Web and social media platforms such as YouTube. Digital media are the rule in 2021 and not the exception as in 2000. Back then, downloading pdfs was still a pleasant exception for the editor (C. Netsch) when doing literature research for his dissertation. Reading microfiche and ordering articles from other libraries was more the standard than the exception.

Why publish a textbook in 2021, when search engines can find everything on the Internet (PubMed, Wikipedia) in milliseconds? The half-life of information has noticeably decreased due to an almost unmanageable number of new urological journals (with and without peer review), which all want or have to be filled with articles on a monthly basis. Journals/articles are created in monthly cycles, whose scientific value sometimes cannot be checked so quickly. These journals today compete with the institutions of then AND today, such as the Journal of Urology or the British Journal of Urology. As a result, a quick, targeted information search in the data jungle of the Internet and a multitude of duplicate publications in important and less important journals with and without impact factors (“publish by numbers”) is not easier for urologists who are not “inside” the topic than in 2000. That is why, we think, textbooks are needed! Here we see all the more the justification for a textbook, whether as a digital or paper edition: to guide the reader through the topic as up-to-date as possible (and necessary) by a selection of high-caliber authors.

Why of all things a book about benign prostate syndrome (BPS)? In a currently oncologically dominated urology, where immunotherapies, receptor blockers or the appropriate sequence therapy for prostate, bladder or renal cell carcinoma are discussed, BPS still represents THE operative backbone of every urological clinic, and this will remain so in the future due to an aging society.

Operative therapies of BPH have come and gone in the last 20 years on the graveyard of medical procedures! Nevertheless, the therapy of BPH is more than tamsulosin, monopolar TUR-P or open simple prostatectomy (OPS)! MTOPS or ComBAT trial have significantly influenced the medical therapy in the last 20 years. Laser ablation procedures with the holmium, thulium, or green light laser have emerged on the surgical horizon to stay permanently. In addition, the so-called Minimally-Invasive Surgical Therapies (MIST: iTind, Urolift, Rezum, Aquabeam, prostate artery embolization) for an individualized tailor-made therapy of BPH are on everyone’s lips. Whether these MIST therapies deliver what they promise remains to be seen.

A critical examination of the mentioned therapies can only succeed in a book with a certain time delay, as the elaborate production of a book always lags behind an original work or a review in terms of time. However, we see this time delay positively: The first “hype” about “new” and “complication-free” procedures is usually gone, critical publications that highlight the disadvantages of certain procedures also appear only with a time delay (or the flow of publications about a procedure dries up slowly). Therefore, a book succeeds much better in critically condensing what a urologist needs to know or what one can know than by skimming articles on various online portals of professional societies or publishers.

Finally, we are pleased that we were able to unite such high-caliber authors from the BPH and Endourology working groups of the German Society of Urology e. V. for the collaboration on this book.

We thank all the staff of Springer-Verlag in Berlin and thank them for their great help and uncomplicated cooperation, especially Ms. Ina Conrad, Ms. Susanne Sobich, Ms. Ellen Blasig and Mr. Amose Stanislaus. Springer-Verlag and all authors hope that this textbook will be a help and guidance for the urologist working in clinic and practice, provide pleasure in reading and above all serve the well-being of our patients.

Table of contents :
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