الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
The most common cause of LUTS in the aging male is Benign Prostatic Hyperplasia (BPH), accounting for more than 50% of men aged 60–69 years and as many as 90% of men aged 70–89 years.
Patients with mild LUTS are commonly reassured having them treated with watchful waiting or lifestyle modification, while medical therapy is targeting those who complain of moderate LUTS, negatively affecting their QOL with no absolute surgical indication.
Patients who cannot tolerate the drugs, whose disease is refractory to treatment, who develop complications of BPH while receiving medical therapy, whose symptoms affect their QOL negatively or who have absolute indications for surgery which are recurrent urinary retention, recurrent UTIs, renal insufficiency, bladder calculi, and recurrent gross hematuria are considered for surgical therapy.
The aim of our study was to compare results, safety and outcome of PAE (the PErFecTED Technique) and Bipolar TURP versus Monopolar TURP for treating LUTS due to BPH in aging males.
In our study, we compared between M-TURP, B-TURP and PErFectED PAE in the management of LUTS due to BPH regarding the intraoperative time, immediate postoperative Haemoglobin and serum Na+ levels, follow up IPSS and QOL questionnaire scores at one and six months and follow up of Uroflowmetry, prostate size and postvoid residual urine at six months postoperatively.
In terms of immediate postoperative complications of haemoglobin loss and serum Na+ level, the loss of Hb for the three groups was more with the M-TURP and B-TURP group than that with PErFecTED PAE being 0.76, 0.57and 0.12 respectively. With a significant relation due to the difference in means between the M-TURP group and PErFecTED PAE group with P-value 0.017. While as for the decrease in serum Na+ level for more with the M-TURP and B-TURP group than that with PErFecTED PAE being 5.80, 3.95 and 1.70 respectively with no statistically significant difference in between the three groups.
The catheter was removed following 3 days for the M-TURP and B-TURP groups while on the fifth day for the PErFecTED PAE group. 20% of the patients of the PErFecTED PAE group developed Post embolization syndrome manifested by severe perianal pain that was relieved with analgesic suppositories (Diclofenac sodium) stayed for 2-3 weeks. 10% of them developed AUR that was unrelieved by the conservative management necessitating other intervention.
One patient of the M-TURP group (5% of the M-TURP group and 1.7% of the whole study) was complicated by TUR syndrome manifested by disturbed conscious level and decreased level of serum Na+ from 148 to 123 mEq/L postoperative that required IV hypertonic saline infusion and monitoring and was corrected on the second day postoperative with increased level of serum Na+ to 132 mEq/L and restored his preoperative conscious level.
Assessment of IPSS and QOL questionnaire scores at one and six months and assessment of uroflowmetry, Prostate size and Post void residual urine after 6 months showed that there was overall improvement of these parameters in the three groups statistically but being more evident in the M-TURP and B-TURP groups than that with PErFecTED PAE group.
Regarding IPSS questionnaire scores, statistically significant difference between the means of M-TURP and PErFecTED PAE of 0.011 and between B-TURP and PErFecTED PAE of 0.001 while as for QOL no statistically significant difference found With difference in means of IPSS between M-TURP, B-TURP and PErFecTED PAE being 18.15, 18.15 and 14.1 respectively. While difference in means of QOL between M-TURP, B-TURP and PErFecTED PAE being 3.2, 3.4 and 2.65 respectively.
Regarding maximum uroflow rate, statistically significant difference between the means of M-TURP and PErFecTED PAE of ˂0.001 and between the means of B-TURP and PErFecTED PAE of 0.007 with the difference in means in the maximum flow rate in M-TURP, B_TURP and PErFecTED PAE being 17.14, 12.77 and 4.7 respectively.
Regarding the average uroflow rate, statistically significant difference between the means of M-TURP and PErFecTED PAE of ˂0.001 and between the means of B-TURP and PErFecTED PAE of 0.013 with the difference in means in M-TURP, B_TURP and PErFecTED PAE being 8.55. 6.5 and 3.1 respectively
As for the prostate size, Statistically significant difference between the means of M-TURP and PErFecTED PAE of ˂0.001 and between the means of B-TURP and PErFecTED PAE of ˂0.001 with The difference in means in the prostate size in M-TURP, B-TURP and PErFecTED PAE being 30.78, 37.26 and 11.42 respectively.
As for The difference in means in the post void residual urine in M-TURP, B-TURP and PErFecTED PAE was 85.34, 128.79 and 146.30 respectively with no statistically significant difference between the means of the three groups.
PErFecTED PAE is giving a statistically significant improvement for patients complaining of LUTS due to BPH in terms of improvement of IPSS and QOL score, uroflowmetry, prostate size and amount of post void residual urine, yet these results are still not comparable to either the M-TURP results or the B-TURP results that still holds the more effective improvement.
PErFecTED PAE may represent a good treatment option in highly selective patients, those who are complaining of LUTS due to BPH, yet they are unfit for surgery or where undergoing surgery is very risky. PErFecTED PAE offers an alternative that can be performed as an outpatient setting, requiring much less hospitalization than TURP.
More studies regarding PErFecTED PAE are needed to discuss intermediate and long-term efficacy, the effect of PErFecTED PAE on erection and ejaculation, the need of retreatment again and cost-effectiveness studies are also needed in order to evaluate the economic benefits of PErFecTED PAE.