Despite the constant technological advances achieved during the past decades, large size benign prostatic hyperplasia (BPH) pathology continues to raise questions concerning the most appropriate therapeutic approach. Interestingly enough, the classical open prostatectomy still represents the standard option for this type of cases despite the substantial perioperative morbidity [1]. [...]

Benign prostatic hyperplasia (BPH) is one of the most common pathologies in aging men, associated with lower urinary tract symptoms (LUTS). This pathology has a multimodal approach depending on different factors like age, prostate size, prostate-specific antigen level, and severity of the symptoms [1]. Medical treatment is the first option in what patients with low or moderate LUTS are concerned. There are two major drug classes already established in all international treatment guidelines, 5 alpha-reductase inhibitors and alpha-blockers. 5 alpha-reductase inhibitors block the transformation of testosterone in dihydrotestosterone within the prostate, leading to the decrease of prostate volume, increased peak urinary flow rate, improvement of symptoms, decreasing the risk of acute urinary retention. Their main secondary effects are the erectile dysfunction, the decreasing of libido and of the ejaculate volume, and also gynecomastia [2]. Alpha-blockers act on alpha-adrenoceptor sites found particularly at the bladder neck, at the trigone and within the prostate. They have a fast action on the prostate gland, leading quickly to symptom relief, but without reducing the risk of acute retention or surgical treatment. As secondary effects, alpha-blockers can affect blood pressure [3-5].

Over the past few years, the conventional transurethral resection of bladder tumors (TURBT) has undergone increasing criticism among the international urological community due to its’ inability to achieve a complete tumor ablation [1]. This substantial oncologic drawback has been mainly related to the limited sensitivity of the classical white light cystoscopy (WLC) [2]. In other words, the standard endoscopic assessment of the bladder was often outlined as insufficiently capable of accurately identifying all of the existing tumor formations [3].

Bladder cancer represents the most common malignancy of the urinary tract and the 7th most frequent cancer in men and 17th in women. The prevalence of this malignancy varies between regions and countries. In Europe for example, the highest age-standardized incidence rate has been reported in Spain and the lowest in Finland (1). In the United States, the incidence and mortality due to bladder cancer is also high (more than 60,000 new cases and up to 13,000 deaths annually) (2). Therefore, in the last decades, it has been noticed an increased prevalence of bladder cancer, probably caused by tobacco abuse, industrial carcinogens risk factors and overall aging process of the population (3). 75-85% of all newly diagnosed bladder tumors is represented by non-muscle-invasive bladder cancer (NMIBC), a multifocal disease, that includes stages pTa, pT1 and carcinoma in situ (CIS) (4). Furthermore, this pathology has a high recurrence rate within the first 5 years after the initial diagnosis (5), despite the recent technological advances (6).

Prostatic pathology represents one of the most common causes of dermato-urological addressability, because of the varied age interval, but also because of the symptoms that decrease rapidly and visibly the patients’ quality of life. Benign prostatic hypertrophy (BPH) is represented by increased volume of the prostate, which generates an obstructive and irritative symptomathology in the pelvic urinary tract. The hormonal influence presents a certain contribution in the development and evolution of BPH, by the imbalance occurred between androgens and estrogens, revealed by the significant decrease of the ratio androgens/estrogens hormones and by the inflammatory factors (1,2,3,4).