Abstract

The dilemma facing urologists dealing with patients complaining of a poor urinary stream and nocturia is whom to treat and how to treat. For the last few decades, most men complaining of these symptoms underwent a prostatectomy, as it was presumed that their symptoms were caused by an enlarged prostate obstructing the bladder outlet. Since "prostatism" was thought to be a progressive disease, related to the inexorable progression of prostatic size, once a man presented to his urologist with symptoms, treatment often followed. The rate of prostatectomy in the United States increased from 30%of men with urinary symptoms in the haven of 1960to nearly 60%in 1990and 1991according to Medicare data.lr' More recently, it has been recognized that 25-30%of men with prostatic symptoms do not actually have outflow obstruction. Even those patients who do have very severe symptoms and what appears to be outflow obstruction, may not need surgery as their symptoms may wax and wane, or they may be satisfactorily relieved with conservative management. Thus, the risk of benefit ratio for prostatectomy for males with symptoms with no clear relationship to bladder outlet obstruction is a problem.

Abstract

Benign prostatic hyperplasia (BPH) is an almost inevitable part of the aging process in men. Symptoms of BPH include slowing and interruption of the urinary stream, incomplete bladder emptying, hesitancy, post-micturition dribbling, frequency and nocturia. These symptoms may not cause an individual any inconvenience, but can lead to considerable interference to quality of life. In more severe cases, and especially if complications such as urinary retention occur, surgical relief of the obstruction is indicated. Traditionally, this has been by trans-urethral resection of the prostate (TURP). However, in the past decade, attempts to find alternative treatments to TURP have been stimulated by the desire to avoid the morbidity of TURP.The use oflaser energy in this context has been evolving rapidly, and is the subject of this review.

Abstract

Percutaneous renal surgery involves instrumentation of the renal collecting system (renal pelvis and calyces) via direct percutaneous access to diagnose and treat a multitude of urological conditions. This chapter will outline the indications, techniques, complications and results of this relatively new and effective operative approach.