Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Benign Prostatic Hyperplasia 231

■Improves symptoms and flow rate less than alpha blocker

■Adverse events: impotence, reduced libido, reduced ejaculate vol-

ume (all sexual related adverse events, about 15% in first year)

Minimally Invasive Therapies

■Most available therapies are heat-based; only mechanical device cur-

rently available is Urolume Endoprosthesis permanent stent

■TUMT (Transurethral microwave thermotherapy)

➣administer microwave-generated heat via an antenna placed in

prostatic urethra

■TUNA (Transurethral Needle Ablation)

➣administer radiofrequency-generated heat via a needle placed

into the prostate

■ILTT (Interstitial laser thermal therapy)

➣administer laser energy via needles into the prostate

Surgical Therapies

■TUIP (Transurethral Incision of the Prostate): indicated for glands

<30 ml

➣Single or double incision into bladder neck by electrocautery or

laser energy

■KTP or “Green Light Laser” Prostatectomy > KTP laser used to ablate

prostate tissue by transurethral approach, no tissue available for his-

tology, nearly bloodless procedure

■TURP (Transurethral Resection of the Prostate): indicated for glands

>30 but <60 ml (transition zone)

➣Resection of the periurethral part of the prostate by electro-

cautery or laser (holmium) energy for either resection or enu-

cleation

■Open surgery: indicated for glands with a transition zone >60 mL or

total volume >100 mL

follow-up

■Yearly follow-up with symptom and bother assessment, DRE and

serum PSA (as long as >10 years life expectancy)

■After initiation of treatment, 3 months

■Standard for each follow-up visit: quantitative symptom assess-

ment and assessment of adverse events; serum PSA if >10 years life

expectancy; flow rate and residual urine optional

complications and prognosis

■Acute and total urinary retention