Laser Но-YAG versus transurethral incision of prostate (ITUP) in treatment of prostate sclerosis areas after chronic prostatitis

Abstract

Introduction. Nowadays, patients suffering from the sclerosis of prostate became a global health problem. The main trigger factor is the presence of chronic prostatitis. This is a consequence of the inflammatory process in prostate, with structure damage tissue. Finally the damaged areas are substituted with fibrous tissue, causing developing of sclerosis in prostate. The surgical treatment of prostate sclerosis should have maximal excision of prostate tissue and minimally temperature impact on surrounding tissue. Aim of the study. Evaluation of the efficiency Но-YAG laser versus ITUP incision in treatment of prostate sclerosis after chronic prostatitis. Materials and methods.. The 46 of patients were selected with the defined diagnosis with sclerosis of prostate after chronic prostatitis during the period from 2018 till 2019. The study was conducted in the Department of urology and surgical nephrology of the State University of Medicine and Pharmacy "Nicolae Testemitanu", within the Republican Clinical Hospital "Timofei Mosneaga". The patients were divided into 2 groups depending on the method of treatment: a control group consisted of 23 patients who underwent ITUP incision and a main group 23 patients were conducted using incision with Но-YAG laser . Results. Surgical treatment was successfully performed for all cases. There were no major intra- or after surgery complications. During all procedures, blood loss was insignificant and no patient required blood transfusions. Also, there were no cases of urinary tract infection, sepsis, bleeding or urinary retention. All patients were able to void spontaneously and was no detected urinary retention or incontinence after catheter removal. Four patients were presenting moderate irritative symptoms (dysuria, hesitance and frequency) and were treated conservatively, with no further complications. In all prostate cancer cases, the pathological specimens were negative for malignancy. The mean operating time was 20 minutes (range 15 to 35 minutes), the duration of catheterization period was 48 hours (range 24 to 72 hours) and the mean hospital stay was 72 hours. Preoperative and at 1, 3 and 6 months after surgery, the mean values for Qmax, were 6.2 ml/s, 15.9 ml/s, 15.8 ml/s and 15.4 ml/s, respectively. Conclusions. The results clearly demonstrate the advantages of using laser energy for treatment of prostate sclerosis compared to ITUP, with significant increase in scores on the IPSS and QoL, maximum urinary flow rate, and a decrease in residual urine volume and frequency of relapses in the group carried out the laser dissection of prostate sclerosis.