Prostatic adenoma, or benign prostatic hyperplasia, is a common condition in men. This benign prostatic hyperplasia presents as obstructive lower urinary tract symptoms (decreased force of the stream, need to push to urinate, sensation of incomplete bladder emptying) and irritative symptoms (frequent voiding of lesser amounts, urgency, leakage). If left untreated, this pathology can lead to complications such as acute urinary retention, recurrent urinary infection, the formation of bladder stones, or renal failure.
In France, more than 2 million men over 50 years of age suffer from urinary symptoms related to benign prostatic hyperplasia.
In case of failure of medical treatment, surgical intervention is proposed. Historically, two techniques have been used: endoscopic transurethral resection through natural channels and open suprapubic adenomectomy, for exceptionally large prostates, requiring an abdominal incision.
The French Health Authority and prostate cancer
Since 1999, the French Health Authority (HAS) has recommended against systematic screening for prostate cancer by PSA testing. It confirmed this opinion in 2010 and 2016 based on 2 large-scale studies, conducted in Europe and the United States. The HAS fears that systematic screening for prostate cancer would lead to the diagnosis of slowly progressive tumors (overdiagnosis) and the treatment of these tumors without improving the patients’ life expectancy (overtreatment).
The emergence of new treatments
- Bipolar vaporization, allowing patients on anticoagulant or antiplatelet therapy (Kardégic®, Plavix®) to be operated on.
- Laser vaporization (Greenlight®), one of the new techniques using a laser, which reduces the duration of hospitalization and reduces intra- and post-operative bleeding. These two techniques are reserved for medium-sized prostates and do not allow for histopathological analysis.
In 1998, the first HOLEP (Holmium Laser Enucleation of the Prostate) laser enucleation was performed in New Zealand. The procedure is performed using an endoscope inserted into the urethral channel. The enucleation is performed by a high-power Holmium laser fiber (100 watts). The central part of the prostate, once released, is fragmented in the bladder using a morcellator. A bladder catheter is placed at the end of the procedure.
HOLEP offers many advantages for patients
In most cases, patients are admitted to the unit on the day of the procedure. The procedure lasts 90 to 120 minutes. Food intake is resumed the same evening, and the bladder catheter is removed the following morning. The patient returns home in the afternoon.
- Significant reduction in the duration of hospitalization.
- Reduction of intra- and post-operative bleeding.
- Possibility of performing the procedure in patients on antiplatelet therapy.
- HOLEP allows for histopathological analysis of the prostate.
- Prostate volume is no longer a limiting factor for the endoscopic approach.
Furthermore, the use of physiological saline as the irrigation fluid during the procedure carries no risk for the patient in case of reabsorption, unlike the fluid used in conventional resection.
Care provided by Doctor Adam Vardi: urologist in Paris
Dr Adam Vardi, urologist at the Centre of Urology of Neuilly, operates at the Clinique de l’Alma and the Clinique Saint-Louis (both equipped with a Holmium Pulse™ 100H laser generator from the Lumenis® company). This allows the surgical treatment of prostatic adenoma or prostatic hypertrophy, or the use of laser enucleation, so that patients can benefit from the many advantages of this innovative technology.