BERKELEY, CA (UroToday.com) - Benign prostatic hyperplasia (BPH) affects nearly 75% of men older than 70 years.
In this age group, there are several comorbidities, and patients are at great surgical risk. Therefore, the established surgical treatment with transurethral resection of the prostate (TURP) bears considerable complications, such as bleeding and TUR syndrome. Among the options of minimally invasive therapy (MIT) is transurethral ethanol ablation of the prostate (TEAP). Ethanol causes coagulative and fibrinoid necrosis of the prostate, as well as lysis of the intraprostatic nerve cells. Improvement of lower urinary tract symptoms (LUTS) occurs due to atrophy and shrinkage of the prostate, and because of a decrease in the urethral tone. In a recent study by El-Husseiny and Buchholz,56 men underwent TEAP treatment under local anesthesia with lidocaine gel, and with an ultrasonography-guided periprostatic block. Dehydrated ethanol was injected via the ProstaJect Ethanol Injection System (PEIS). Patients were followed up (at 6 weeks, at 6 months, and every 1 year) with the international prostate symptom score (IPSS), prostate-specific antigen (PSA), prostate volume measured with transrectal ultrasonography, post-voiding residual (PVR), and Qmax. During follow-up, there was no TEAP-related mortality. The mean prostate volume decreased from 53 cc to 34 cc at 12 months, and the PVR decreased from 180 ml to 104 ml. The mean Qmax increased from 8 ml/sec to 15 ml/sec after 1 year, while the mean IPSS decreased from 16 to 10. In total, 43 (77%) patients showed a sufficient response, while the remainder 13 (23%) underwent alternative treatment. The retreatment point varied from 6 months to 3 years. Ethanol is an inexpensive, well-known sclerosing agent that is relatively easy to use. This study demonstrated that TEAP is safe, feasible, and efficacious in high-risk, elderly patients. However, there was a considerable drop-out rate during the follow-up, mainly because of a patient’s comorbidities. Also, 1 year after TEAP, some parameters such as IPSS, Qmax, and prostate volume changed again, indicating that further follow-up is needed. In conclusion, the TEAP treatment may be of special importance in managing high-risk patients with symptomatic BPH who are not candidates for other surgical modalities. The results of larger-scale, long-term, multi-institutional trials are warranted.
- El-Husseiny T, Buchholz N. Transurethral ethanol ablation of the prostate for symptomatic benign prostatic hyperplasia: long-term follow-up. J Endourol 2011 Mar;25(3):477-80.
Athanasios Papatsoris MD, MSc, PhD, FEBU, FES, Et Al., as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.