Intervention techniques for the surgical treatment of Benign Prostatic Hypertrophy (BPH).
The following presents a general overview of the surgical techniques currently used for the treatment of IPB.
- Size of the prostate adenoma
- Findings of transrectal ultrasound
- Age, general conditions and possible pathologies of the patient
- Any concomitant pathologies of the patient
- Potential side effects inherent to the various techniques.
It follows that it is essential that the patient completely entrusts to the surgeon the choice of the technique to use, on the basis of the existence of a total confidence that the patient must have in the surgeon himself and in his ability to correctly use the various alternative techniques.
Having said that, a first major subdivision concerns the carrying out of the surgery through an incision made in the subpubic or perineal area or through the patient's urethral canal. In this last case, no “cut” is made.
Despite having a century of life and more, the incision technique (laparatomy) is still used, nowadays using less invasive laparoscopic techniques, in particular cases, for example, of very large prostates (over 200 grams) or in conjunction with any patient patologies.
As for the techniques performed through the urethral canal (endoscopic), it should be noted that they are divided into a whole series of variants that involve as many acronyms that are not easy to understand for the layman. It is therefore preferred in this description addressed to the non-medical patient to group the different techniques on the basis of two main parameters: the type of energy used to gradually destroy the adenomatous tissue inside the prostate and the physical nature of the fragments that are gradually produced as residue of the application of the above energy.
It should be noted that all endoscopic techniques have in common the use of an equipment which consists of an energy generating station with monitor and control module connected to a terminal which is introduced into the urethra and which is articulated, in turn, into an adenoma breaker activated by the energy generated by the external station and in a micro-camera that allows the operator to see the inside of the prostate (operative scenario) during the demolition of the adenoma. The fragments generated by the demolition and generally "parked" in the bladder are removed by means of a mechanical extractor or a suitably carried out washing.
In the 1970s, the first transurethral technique was adopted in Italy, named TURP (TransUrethral Resection of the Prostate). The adenoma was mechanically reduced in mall particleswhich were then in turn removed by a mechanical extractor again via the urethra.
In the following years this technique, in order to reduce the inconveniences and risks that could occur in the operative and postoperative phases as well as the hospitalization and convalescence times, was improved by acting on the two parameters previously indicated: type of energy used and nature of the residues of the demolished fabric. For this purpose, the use of electricity was introduced with initially unipolar and then bipolar terminals and, subsequently, energy generated by various types of lasers (Holmium, Thulium, 532nm Greenlight laser). The latter allow the demolition of the adenomatous tissue with various types of residues up to vaporization in cases of not too voluminous adenomas.
For the sake of completeness, it must be said that there are other technologies based on radio frequencies and thermal energy. Their use, however, has not reached the degree of reliability typical of the techniques mentioned above.
For an in-depth study of the techniques in use by Professor Giulianelli click here.
Hereunder are some interesting videos that illustrate some advanced techniques used by Professor Giulianelli and his team. Click on the titles to access the respective videos.