Year : 2014 | Volume
: 30 | Issue : 2 | Page : 169-
BPH management today
Altaf Mangera, Christopher R Chapple
Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, United Kingdom
Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield
|How to cite this article:|
Mangera A, Chapple CR. BPH management today.Indian J Urol 2014;30:169-169
|How to cite this URL:|
Mangera A, Chapple CR. BPH management today. Indian J Urol [serial online] 2014 [cited 2019 Oct 13 ];30:169-169
Available from: http://www.indianjurol.com/text.asp?2014/30/2/169/126899
It gave us immense pleasure in compiling this special symposium on benign prostatic hyperplasia/benign prostatic obstruction (BPH/BPO) for the Indian Journal of Urology, Apr-Jun 2014, Vol 30, Issue 2, which is a first in its history. In 1788, John Hunter, Master Surgeon at the St George's Hospital London, gave a detailed account of hyperplasia of the lateral prostatic lobes leading to thickening of the bladder with dilatation of the ureters and kidneys. Subsequently, it took approximately 50 years before descriptions of suprapubic prostatectomy were published, and it was Sir Peter Freyer of St. Peters Hospital, London, who was accredited with the popularization of what is now called "the Freyer prostatectomy." Across the Atlantic Ocean, the perineal prostatectomy was also popular and was introduced in Baltimore, USA, in 1903. Subsequently, in 1945, Millin described the retropubic prostatectomy without opening the bladder with transurethral drainage leading to earlier recovery. However, looking through the annals of history, the surgical team of Sushrata of Benares, India, described the surgical treatment of BOO and bladder stones over 2000 years ago. At a similar time, the Chinese and Egyptians used catheterization as a method of relieving acute retention.
Much has changed since the middle of the 20 th century with the development of pharmacotherapy such as alpha antagonists and, more recently, 5-alpha reductase inhibitors. Subsequently, there has been a recognition of the importance of storage symptoms in male lower urinary tract symptoms (LUTS) associated with benign prostatic enlargement leading to bladder outlet obstruction. There is increasing evidence that anticholinergics are useful in some patients, and more recently, the PDE5 inhibitor tadalafil has been licensed in many parts of the world for male LUTS. In 2014, we now have potential combination therapies available. The shift in emphasis has therefore been from a purely surgical approach to the management of BPO, to the incorporation of a number of pharmacotherapeutic modalities. Clearly, there are a number of other possible options being explored at present as we increasingly recognize the importance of the sensory system and the manner in which the bladder and prostate function as a single functional complex.
Clearly though, surgical intervention remains extremely important. Just as in the development of medical therapies, surgical and, more so, technological innovation has led to a myriad of surgical options with multiple laser sources, power outputs and waveforms leading to adenoma coagulation and/or vaporization and thus different techniques of de-obstruction. As occurs with all new technologies, early adopters show great enthusiasm and report favorable results. In this issue, we hope to give you a balanced report of the evidence regarding these evolving techniques.
Besides management of symptoms, the complications of BPH/BPO also require specialist input, and this review provides useful algorithms in managing these complications. A number of predictors for progression have been identified in recent years, although it is well recognized that not all men who present with male LUTS associated with BPH will necessarily have progression of their symptoms. Nevertheless, it is clearly established that increasing age, a larger prostate and elevated prostate-specific antigen (in the absence of malignancy) and histological evidence of inflammation in the prostate indicate a tendency to progression. Until now, the focus of assessment has been to determine disease severity and to decipher who will benefit from surgery by the use of cystometry.
We hope that in the future we may be able to refine our understanding of these potential biomarkers for the disease process. Indeed, there are other elective approaches. Injection of toxin into the prostate has been explored but, unfortunately, use of botulinum toxin despite its early promise failed to prove effective in Phase III studies, although other toxins are currently under early research evaluation. Clearly, the interface between benign and malignant prostate disease is an important one that needs to be explored further in the future.