[Non-surgical instrumental treatment of benign hypertrophy of the prostate].
Although surgery remains the treatment of reference for symptomatic benign hypertrophy of the prostate, the requirement for locoregional anaesthesia, the risk of complications and the major financial burden for the health care system have led to research into alternative therapies. Basically two categories have been developed, thermal and mechanical. The sensitivity of the hypertrophic prostate tissue to heat depends both on histology and blood flow. It is generally accepted that temperatures < 60 degrees C do not cause definitive tissue damage, that those > or = 60 degrees C lead to necrose of the coagulated tissue and > or = 100 degrees C cells are vaporized producing tissue debris. Currently, thermoablation (temperature > 60 degrees C) is the only thermal alternative which gives results within a range comparable with classical surgery. The more simple techniques (microwaves, focalized ultrasounds, interstitial radiofrequency waves, lateral or interstitial laser) have the disadvantage of aggravating symptomatology in certain patients, limiting indications. More sophisticated techniques (contact radiofrequency, contact laser) still need improvement to reach the level of surgery. Mechanical alternatives include resorbable and non-resorbable stents and dilatation. Stents are a particularly promising route but have the inconvenience of being difficult to implant and sometimes leading to complications (infection, incrustation, calcification). Dilatation procedures have been tried for many years using various methods of control, but results have been disappointing to date. Surgery thus remains the reference treatment for benign hypertrophy of the prostate, but ongoing research emphasizes the need for successful alternatives.