Prostatic Balloon Dilatation in 115 Unequivocally Obstructed Patients

Nonsurgical, nonpharmacologic treatment of benign prostatic hyperplasia

New treatment modalities are becoming available for benign prostatic hyperplasia. Permanent or temporary stenting of the prostatic urethra, balloon dilatation of the prostate, and hyperthermia and thermotherapy are in the forefront. None of the methods has found a definite place in the spectrum of indications. Prospective trials are needed to ascertain the safety, efficacy, and durability of results.

Surgical treatment of prostatic hyperplasia

BACKGROUND

For more than seven decades prostates have been enucleated surgically, and for almost six decades they have been resected endoscopically. Results have been impressive and increasingly better, and the procedure has been reasonably safe. Variations to these two approaches have abounded and have made it safer, quicker, and easier, but never cheaper.

METHODS

Currently, an abundance of alternatives have surfaced and for a variety of reasons. All alternatives share several shortcomings: results are not predictable, there is no tissue, and serendipitous prostate cancer could be missed. In addition, it may be categorically said that rarely does any of the alternatives achieve the effectiveness of prostatectomy that is appropriately indicated and properly performed.

RESULTS

Urologists should participate in an objective assessment of the comparative merits and deficiencies of the variations of and alternatives to prostatectomy. Assessment of outcomes, safety, efficacy, and cost, as well as the development of guidelines, should continue.

CONCLUSIONS

With our counsel and the government's reimbursement, the public will decide which alternatives are safe and reasonably effective and should survive.

Balloon dilatation of prostate: Keys to sustained favorable results

Seventy-seven patients with small prostates (less than 40 g) and significant obstructive symptomatology were treated using balloon dilatation of the prostate (BDP) with a sized-to-fit intra-prostatic balloon. Eighty-seven percent of the patients experienced a 50 percent or greater decrease in symptom score at longest follow-up (12.0 months, average: 3-24 months, range). Forty-nine percent of the patients had a 50 percent or greater improvement in peak uroflow. An anterior commissurotomy through the fibromuscular stroma was consistently found and is the hallmark of a technical and therapeutic success. No cases of incontinence, retrograde ejaculation, or impotence developed. When properly performed, BDP has a place in the spectrum of BPH treatment alternatives.