Dyachuk M. Rationale for the choice of integrated application of photoselective laser vaporization and transurethral resection in patients with benign prostatic hyperplasia

The thesis deals with a substantiation of the method of prostate laser vaporization for the surgical treatment of benign prostatic hyperplasia. The effectiveness of different methods of the surgical treatment has been compared, such as: transurethral resection of the prostate (40 patients), laser vaporization (31 patient), open prostatectomy (40 patients), modified laser vaporization in case of prostate volume < 80 ml (33 patients) and modified laser vaporization in case of prostate volume > 80 ml (36 patients). The effectiveness of abovementioned methods assessed by the urination function follow-up (IPSS, uroflowmetry and residual urine volume) and clinical characteristics of patients (intra- and postoperative complications) along the steps of the study: before surgery; after catheter removal; in 3, 6 and 12 months of postoperative follow-up. The study clarified the scientific data on the pathogenesis of intra- and postoperative specific complications associated with the use of standard (classical) techniques of laser vaporization and transurethral resection of the prostate. The study revealed the pathomorphological characteristics of prostate tissue in patients with benign prostatic hyperplasia under the impact of the diode laser with a wavelength of 940 nm. These changes were as follows: the presence of prostatic tissue layer with a thickness of 3-4 mm and the signs of coagulative necrosis of red blood cells in the vessels; this tissue layer was detected under the layer of carbonized prostatic tissue; the presence of preserved stroma of the gland. The modified technique of laser vaporization of the prostate gland has been worked out and substantiated. This technique consisted in the integrated application of the laser vaporization by diode laser with a wavelength of 940 nm and monopolar transurethral resection of the prostate.The comparative evaluation of the efficacy of surgical treatment of benign prostatic hyperplasia was provided by the Clavien-Dindo classification of postoperative complications. The advantages of the integrated application of photoselective laser vaporization and monopolar transurethral resection were determined according to the less number and severity of postoperative complications.