الفهرس 
Management of BPHOnly 14 pages are availabe for public view
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Abstract
Lower urinary tract symptoms commonly affect older men and are often consistent with benign prostatic hyperplasia. BPH leads to narrowing of the lower urinary tract and places pressure on the base of the bladder. Although not life-threatening, untreated BPH can lead to bladder and kidney disorders.
For over 50 years, the cornerstone of BPH treatment was transurethral resection of the prostate.
Since the advent of medical therapy for symptomatic prostatic hypertrophy with 5-alpha reductase inhibitors and alpha-adrenergic blockers, the need for immediate surgical intervention in symptomatic prostatic obstruction has been reduced substantially.
However, alpha-blockers do not modify prostate growth, and even the use of prostatic growth inhibitors such as finasteride often fails to prevent recurrent urinary symptoms of BPH and retention. In the past, these patients would almost certainly have undergone TURP years earlier.
Transurethral resection of the prostate has been shown to be the most efficient treatment for patients with LUTS secondary to BPH, and among the surgical procedures TURP remains the ‘gold standard’. Despite the great improvement in urinary flow rate and IPSS achieved as a result of transurethral resection of the prostate. TURP-related morbidity, such as bleeding and transurethral resection TUR syndrome, and mortality are of some concern.
As a result, there have been considerable efforts to develop alternatives to TURP including medical therapies and minimally invasive mechanical procedures.
In the 1990s, waves of new procedures have been evoluted as possible alternatives to TURP; one of these was laser prostatectomy.
During this period, various lasers were introduced including the Neodymium: Yttrium Aluminium Garnet (Nd: YAG) laser, the Holmium (Ho): YAG laser and the frequency doubled Nd: YAG laser (also known as the potassium titanyl phosphate laser KTP laser).
However, these efforts failed to replace TURP as the treatment of choice because too little power was applied at sub-optimal wavelengths.
The recent introduction of more powerful lasers has led to resurgence in interest in laser prostatectomy. The lasers discussed in this essay include KTP lasers, lithium triborate (LBO) laser and holmium laser, diode laser and thulium laser .
In general, laser prostatectomy using more modern lasers is a therapy that can be offered to most patients with benign prostatic hypertrophy (BPH) including those with larger glands and those recently on oral anti-coagulant therapy.
Surgical times seem to be measurably longer than would be the case with standard trans-urethral resection of the prostate (TURP), although this difference may be only of the order of 10 minutes, but post procedural catheterization times and hospital lengths of stay are shorter.
Functional outcomes in the short and medium term, as determined by urinary flow rates and residual volumes seem to be equivalent for laser prostatectomy and TURP. Overall, it seems fair to conclude that laser prostatectomy is now non-inferior to TURP.
Moreover, laser prostatectomy is less expensive because of the savings made by a reduced length of stay. Upfront costs of laser prostatectomy may be substantial given the capital costs of lasers.
It seems reasonable to conclude that laser prostatectomy is a therapy that is a reasonable, safe and cost-effective alternative to TURP or open prostatectomy for the treatment of BPH.
Overall, the more common laser prostatectomy procedures (KTP, PVP and HoLEP) appear to be at least as safe and effective as TURP for the treatment of BPH.