S Lebdai1, A Chevrot2, S Doizi3, B Pradère4, N Barry Delongchamps5, H Baumert6, A Benchikh7, E Della Negra8, M Fourmarier9, J Gas10, V Misraï11, Y Rouscoff12, P E Theveniaud13, S Vincendeau14, J Wilisch15, A Descazeaud16, G Robert17. 1. Service d'urologie, CHU d'Angers, Angers, France. Electronic address: souhil.lebdai@gmail.com. 2. Service d'urologie, CHU de Nîmes, Nîmes, France. 3. Service d'urologie, hôpital européen Georges-Pompidou, Paris, France. 4. Service d'urologie, CHU de Tours, Tours, France. 5. Service d'urologie, hôpital Cochin, Paris, France. 6. Service d'urologie, hôpital Ambroise-Paré, Paris, France. 7. Service d'urologie, Clinique les Martinets, Versailles, France. 8. Service d'urologie, hôpital des Côtes d'Armor, Saint-Brieuc, France. 9. Service d'urologie, hôpital Aix-en-Provence, Aix-en-Provence, France. 10. Service d'urologie, CHU de Toulouse, Toulouse, France. 11. Service d'urologie, clinique Pasteur, Toulouse, France. 12. Service d'urologie, polyclinique Saint-Georges, Nice, France. 13. Service d'urologie, CHR de Metz Thionville, Metz, France. 14. Service d'urologie, CHU de Rennes, Rennes, France. 15. Service d'urologie, hôpital privé Natecia, Lyon, France. 16. Service d'urologie, CHU de Limoges, Limoges, France. 17. Service d'urologie, CHU de Bordeaux, Bordeaux, France.
Abstract
OBJECTIVE: The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS: All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES: Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION: Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.
OBJECTIVE: The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS: All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES: Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION: Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.