Endoluminal Treatment of Prostate Hyperplasia Lower urinary tract symptoms caused by endoluminal bladder outlet obstruction (BOO) of prostate hyperplasia are the most common reason for older men to visit urology clinics, while benign prostatic hyperplasia (BPH) is the most important cause of BOO. With the pursuit of the mainstream direction of minimally invasive technology and the development and application of modern technology, the endoluminal minimally invasive treatment technology for prostate is developing rapidly on the basis of transurethral resection of the prostate (TURP). TURP is the “gold standard” of intracavitary minimally invasive treatment. As the earliest minimally invasive technique successfully carried out by modern medicine, TURP is still regarded as the “gold standard” after continuous development. The principle of TURP is to convert high-frequency electric current through a ring electrode to produce electric cutting and electrocoagulation, to cut the hyperplastic prostate tissue through the urethra and to stop bleeding during the cutting process. Operatively, Nesbit’s approach, Milner’s approach, and various other excision techniques have been developed depending on the sequence of tissue removal during the operation. In order to avoid complications such as the prostate electrosurgical syndrome due to excessive absorption of intraoperative bladder irrigation fluid and bleeding, the surgical cutting time is generally required to be controlled at 60-90 min. Due to the limitation of the surgical time, some scholars have suggested that open surgery or other TURP alternatives are preferred for particularly large prostates. In addition, Agrawal et al. showed that hemicolectomy of the prostate is a feasible method for patients whose conditions do not allow it. Short-term postoperative follow-up did not significantly differ from the results of conventional resection. More than 2200 cases of TURP were performed in our hospital, and more than 97% of the patients were able to pass urine; five cases developed mild postoperative urinary incontinence, which recovered after one week to three months of treatment. All cases did not have true urinary incontinence, and 16 patients had early TUR syndrome, which was cured after diuresis and sodium supplementation. TURP operation time should not be too long, usually not more than 1 hour, otherwise the intraoperative and postoperative complications are high, and TUR syndrome as well as urethral stenosis are likely to occur. During the operation, try to take direct vision into the mirror, to avoid damage to the urethra or the bladder triangle; meticulous hemostasis during the operation, if the venous sinus is found to be open, the operation should be ended as soon as possible; for the elderly, general conditions of the poor patients, palliative electrodesection or split electrodesection can be taken. New technology should grasp the indications There are three main types of lasers used to treat prostate enlargement: neodymium laser, holmium laser and potassium titanium phosphate laser. Laser treatment of prostate hyperplasia uses heat energy for coagulation, necrosis and vaporization to achieve the purpose of making tissues gradually fall off or vaporize and cut. Different wavelengths of laser have different tissue effects. Currently applied to prostate treatment is high-power KPT laser, commonly known as green laser. Its average power is 80W and its wavelength, 532nm, is a kind of visible light. Its main mode of action is selective photovaporization of the prostate. The laser light is transmitted through the optical fiber and acts on the tissue in a non-contact manner. The KTP laser energy is delivered to act on the prostate tissue in its entirety, and the energy is efficiently deposited on the tissue, resulting in vaporization and coagulation, and precise cutting of the tissue. As the penetration depth of green laser is only 800pm, the coagulation band produced in the process of vaporization is thin, about 1~2mm, and the hemostatic effect is good, and the surgical field is clear. Green laser treatment of prostate hyperplasia has the characteristics of exact hemostasis and high surgical safety, which is especially suitable for patients of high age, high risk and those whose prostate volume is not very large. However, its vaporization speed is slow, and the surgical effect is not good for patients with prostate volume greater than 80g. Intraoperative vaporization depth should be understood, not in a part of the vaporization time is too long, to avoid damage to the prostate peritoneum; to pay attention to the sign of the seminal caruncle, seminal caruncle on both sides of the prostate tissue should be accurately and appropriately vaporized, to avoid the impact of postoperative urinary function. Because of its vaporization surgery, the specimen cannot be retained for pathological examination after surgery, so prostate cancer should be excluded before surgery. Future development trend of endoluminal technology People have been inspired by the traditional open prostate enucleation to find the combination of open surgery and endoluminal surgery, such as transurethral enucleation followed by resection of the prostate (TUERP), which has led to the development of a number of new surgical methods. TUERP is a new technique pioneered in China. Due to the skillful combination of endoluminal surgery and open surgery, the short-term postoperative results are similar to TURP with fewer complications. At the same time, it can achieve long-term results similar to those of open surgery, so it is very promising and currently has a tendency to replace TURP. Although the development and widespread use of pharmacotherapy has made the indications for choosing invasive therapeutic measures more stringent, the endoluminal minimally invasive technique represented by TURP is still the most effective method for treating bladder outlet obstruction due to prostatic hyperplasia. How to achieve the most effective resection with minimal trauma, thus reducing surgical complications and achieving ideal short- and long-term follow-up results, remains a direction for the development of such techniques now and in the future.