Benign Prostate Syndrome: Diagnostics and Therapy of the BPS

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