The search for a minimally invasive approach to the treatment of Lower Urinary Tract Symptoms (LUTS) suggestive of Benign Prostatic Hyperplasia (BPH) is probably as old as Transurethral Resection of the Prostate (TURP). In an effort to overcome the limitations and morbidities of TURP, and in light of evidence suggesting that medical treatment for BPH has a limited life-span, laser-based treatments have emerged during the last decade. Photoselective Vaporization of the Prostate (PVP) by the "GreenLight" KTP laser is considered one of the most promising options, one that is constantly evolving new technologies in prostate surgery. In this overview of KTP laser usage in BPH treatment, we will briefly discuss the evolution of this modality since it was first introduced and focus on the available evidence regarding safety, efficacy and cost parameters of its application.
Humans ; Laser Therapy/*methods/trends ; Male ; Prostate/pathology/*surgery ; Prostatic Hyperplasia/*surgery

OBJECTIVETo investigate the clinical features, diagnosis and surgical treatment of giant prostatic hyperplasia

METHODSWe retrospectively analyzed the clinical data of 1 case of GPH, and reviewed the relevant literature published at (GPH). home and abroad.

RESULTSThe patient was 77 years of age. The main clinical features were increased nocturnal urine and gross hematuria. The maximum urinary flow rate was 10 ml/s, the total PSA was 37 pIg/L and the prostate volume was 11 x 10 x 8 cm. Suprapubic prostatectomy was performed successfully, and the removed prostate weighed 450 g. Pathologic examination showed the case to be benign prostatic hyperplasia. The patient was discharged 21 days after surgery, without any obvious complications. We identified 83 cases with the prostate weighing over 200 g in the domestic literature, and 14 cases with the prostate volume exceeding 500 g in the foreign literature, mostly treated by suprapubic prostatectomy and only a few by retropubic prostatectomy.

CONCLUSIONGPH, as a rare entity whose nomenclature is not yet agreed-on, can be diagnosed according to its clinical manifestations and the results of transrectal ultrasonography and prostate CT. Surgical methods most frequently adopted for its treatment include transurethral prostatectomy, transvesical suprapubic prostatectomy, retropubic prostatectomy, and laparoscopic prostatectomy.

Aged ; Humans ; Male ; Prostate ; pathology ; Prostatectomy ; Prostatic Hyperplasia ; diagnosis ; pathology ; surgery ; Retrospective Studies

OBJECTIVETo evaluate therapeutic effects suprapubic transvesical prostatectomy with opening the prostatic cavity wide on BPH with small volume.

METHODSFrom Aug 1994 to Dec 2003, fifty-six patients with BPH of small volume were treated by suprapubic trans vesical prostatectomy with opening the prostatic cavity wide.

RESULTSForty-two patients have been followed up for 3 approximately 22 months. Neither incontinence nor bladder outlet obstruction had been observed. IPSS, QOL and PVR decreased from (31.0 +/- 2.3) score, (4.5 +/- 0.4) score and (230.0 +/- 30.0) ml (pre-operative) to (7.5 +/- 2.0) score, (1.5 +/- 0.5) score and disappearance (post-operative) respectively. All these differences were statistically significant (P <0.01).

CONCLUSIONThe procedure is effective for the patient with BPH of small volume.

Aged ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Hyperplasia ; pathology ; surgery

OBJECTIVETo explore the possibility of injury to the striated urethral sphincter by incision to the anterior lobe region in transurethral prostatectomy.

METHODSWe incised the anterior lobe region of 60 patients with benign prostatic hyperplasia (BPH) undergoing transurethral prostatectomy. The patients were divided into four groups according to the incision fields: proximate superficial (group 1), proximate deep (group 2), distal superficial (group 3) and distal deep (group 4). The tissues taken from the anterior lobe region were subjected to HE staining, and the smooth and striated muscles were detected by immunohistochemical identification of smooth muscle actin (SMA) and myoglobin (MYO) in the tissues. The prostate volume, age, and PSA level of the patients were analyzed against their positive or negative results. The relative contents of the striated muscle were compared among groups 2, 3 and 4. The independent-sample between-group t-test was used for statistic analysis.

RESULTSThe urethral rhabdosphincter was found in the anterior lobe region, with the smooth muscle intermixed with the striated muscle. The incision injury of the urethral rhabdosphincter was associated with the prostate volume. Increased urethral rhabdosphincter was observed in the anterior lobe region, approaching the apex of the prostate and extending to the urethral lumen.

CONCLUSIONThe anterior lobe region should not be excessively incised in transurethral prostatectomy so as to avoid direct injury of the striated urethral sphincter, which is especially important for prostates of smaller volume or operation near the apex of the prostate.

Aged ; Histological Techniques ; Humans ; Male ; Prostate ; anatomy & histology ; pathology ; Prostatic Hyperplasia ; pathology ; surgery ; Transurethral Resection of Prostate ; Urethra ; anatomy & histology ; pathology

Aged ; Antigens, CD20 ; metabolism ; Humans ; Leukocyte Common Antigens ; metabolism ; Lymphoma, B-Cell ; complications ; metabolism ; pathology ; surgery ; Male ; Prostate ; pathology ; Prostatectomy ; Prostatic Hyperplasia ; complications ; metabolism ; pathology ; surgery

OBJECTIVETo study the clinicopathologic features of 30 cases of pseudohyperplastic prostatic adenocarcinoma (PHPA).

METHODSEight hundred and sixty cases of ultrasound-guided prostatic needle biopsy and 46 cases of radical prostatectomy specimens collected during the period from January 1, 2005 to December 31, 2006 were retrieved from the archival files. The incidence, morphology, pathologic differential diagnosis, tumor volume, preferred location and Gleason's score were studied. The tissue sections suspicious for PHPA were immunohistochemically stained with high-molecular weight cytokeratin (34betaE12) or CK5/6, p63, AMACR, and cocktail antibody of 34betaE12/p63/AMACR. Cases with PHPA component more than 60% in at least one single slide were selected and pathologically analyzed.

RESULTSPHPA was present in 7% of needle biopsy and 15.2% of prostatectomy specimens. Histologically, 66.7% of PHPA demonstrated direct transition with conventional acinar adenocarcinoma; and 76.7% of cases had coexisting conventional acinar adenocarcinoma in the remaining tissue blocks. The tumor volume accounted for 5% to 100% of total carcinoma among core needle biopsy and 1% to 30% of total carcinoma among radical prostatectomy. PHPA resembled benign prostate glands, in which the hyperplastic malignant acini were predominantly of medium to large size. The neoplastic cells were well-differentiated, with basally located nuclei and luminal corpora amylacea. However, amongst the 20 pathologic indices of prostatic malignancy studied, occurrence of 10 or more indices exceeded 66.7%. Although PHPA looked benign morphologically, 66.7% cases had stromal invasion, 6.7% had perineural invasion and 3.3% had bone metastasis. The tumor was primarily located in the peripheral zone.

CONCLUSIONSPHPA is not a rare phenomenon in prostatic adenocarcinoma. Majority of cases have concurrent conventional acinar adenocarcinoma. It is different from well-differentiated (with Gleason's score 1 or 2) adenocarcinoma with a relatively indolent clinical course. In contrast, PHPA corresponds to moderately differentiated adenocarcinoma with Gleason's score of 3.

Adenocarcinoma ; metabolism ; pathology ; surgery ; Biopsy, Needle ; Carcinoma, Acinar Cell ; metabolism ; pathology ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Immunohistochemistry ; Male ; Prostatectomy ; Prostatic Hyperplasia ; metabolism ; pathology ; surgery ; Prostatic Neoplasms ; metabolism ; pathology ; surgery ; Racemases and Epimerases ; metabolism

OBJECTIVETo investigate the pathohistological characteristics of the prostate tissues in patients who receive a second TURP and to evaluate their clinical significance.

METHODSWe collected surgical specimens from 50 cases of TURP (the control group) and another 50 cases of re-TURP (the re-TURP group), detected the expressions of CD34, vascular endothelial growth factor (VEGF) and androgen receptor (AR) in the prostate tissues by immunohistochemistry (S-P), and determined microvessel density (MVD) and the expressions of VEGF and AR. We performed statistical analyses on the results obtained from the specimens of the control group as well as from those of the first and second operations of the re-TURP group.

RESULTSVEGF and AR expressed in all the specimens. The expressions of VEGF and AR and MVD were significantly higher in the re-TURP group than in the controls (P < 0.05), but showed no significant differences between the first and second operations in the re-TURP group (P > 0.05). Positive correlations were found between the expressions of AR and VEGF, VEGF and MVD, and AR and MVD (r = 0.650, 0.705 and 0.525, P < 0.05).

CONCLUSIONIncreased AR, VEGF and MVD in the prostatic tissues may be one of the important causes of recurrence of BPH after TURP, and could be considered as the risk factors for postoperative recurrence and targeted indicators for preventive measures.

Humans ; Male ; Prostatic Hyperplasia ; metabolism ; pathology ; surgery ; Receptors, Androgen ; metabolism ; Reoperation ; Transurethral Resection of Prostate ; Vascular Endothelial Growth Factor A ; metabolism

Carcinoma ; genetics ; metabolism ; pathology ; surgery ; China ; Humans ; Male ; Oncogene Proteins, Fusion ; genetics ; Prostatic Hyperplasia ; genetics ; metabolism ; pathology ; surgery ; Prostatic Neoplasms ; genetics ; metabolism ; pathology ; surgery ; Proto-Oncogene Proteins c-ets ; genetics ; metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Serine Endopeptidases ; genetics ; metabolism

OBJECTIVETransurethral electrovaporization of the prostate (TVP) for benign prostatic hyperplasia (BPH) has proven to be efficacious with lower morbidity than transurethral resection of the prostate (TURP) on clinical studies. However, no histopathologic data are available to support the clinical findings in human studies. The following study was done using a canine model in an effort to evaluate these histopathologic changes.

METHODSNine canines received antegrade electrovaporization or resection of the prostate, via an open cystoma, using Storz series resectoscope and video equipment. The dogs were sacrificed and their prostates harvested at 0 week (immediately after operation), 1 week or 5 weeks after electrovaporization or resection. The prostates were evaluated grossly as well as histologically for cavitary defects and depth of necrosis.

RESULTSProstate examination revealed superficial necrosis (less than 1.8 mm deep) at 0 week following the 270 watts operation, and less than 3 mm deep necrosis with acute inflammation and focal hemorrhage at 1 week. The depths of necrosis were less than 1.3 mm and 2.2 mm at 0 week and 1 week after the 180 W electrovaporizion. And the 120 W resection resulted in necrosis 1.1 mm and 1.6 mm deep at most, which was localized in the vaporized prostate only, with no histopathologic change in the surrounding tissues. Epithelial stratification was underway by the fifth week, but with inflammation.

CONCLUSIONTVP in the canine model showed only shallow necrosis at the site of the vaporization. These data provide a histopathologic rationale for the minimal morbidity and efficacious nature of this technique demonstrated in clinical studies.

Animals ; Disease Models, Animal ; Dogs ; Electrosurgery ; adverse effects ; Male ; Prostate ; injuries ; pathology ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; adverse effects ; Urinary Bladder ; surgery

OBJECTIVETo compare the therapeutic effects of the greenlight photoselective vaporization of prostate (PVP) and transurethral electrovaporization resection of prostate (TUVP) for the treatment of symptomatic benign prostatic hyperplasia (BPH).

METHODSOne hundred and sixty-three cases of BPH were treated with PVP and TUVP. All patients were followed up with International Prostatic Symptom Score (IPSS), quality of life (QOL), blood loss, operative time, indwelling catheterization, mean Qmax, residual urinary volume (RUV) and operative complications.

RESULTSIPSS, QOL, Qmax and RUV were significantly improved after either of the procedures (P < 0.05), no significant difference in the improvement of subjective symptoms and objective signs had been noted with the different procedure (P > 0.05). Mean operative time was (37 +/- 15) min for TUVP and (45 +/- 28) min for PVP, the resection time was longer for PVP than TUVP (P > 0.05), but the intraoperative bleeding and catheterization time were less for PVP than TUVP (P < 0.05). Postoperative complications were less for PVP than TUVP (P < 0.05). The incidence of hematuria in TUVP group had been 41.4%, and urinary irritation after PVP group was 55.2% (P < 0.05).

CONCLUSIONSPVP has the same therapeutic effect as TUVP and less adverse side effects than TUVP. It is a new technique for the treatment symptomatic BPH.

Aged ; Aged, 80 and over ; Follow-Up Studies ; Humans ; Laser Therapy ; Male ; Middle Aged ; Prostate ; pathology ; surgery ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Transurethral Resection of Prostate ; methods ; Treatment Outcome