BPH: Interventional therapy in benign conditions of the prostate

Buy Lab Tests Online

madman

Super Moderator
Abstract

Interventional therapies (IT) are increasingly popular treatment options for benign prostatic hyperplasia (BPH). IT aim to reduce morbidity and side effects related to invasive surgical procedures. To date, IT are considered experimental, though they are evolving rapidly and starting to challenge established surgical strategies. With gradually increasing evidence for the benefits of IT in BPH, several techniques are moving out of the realm of research and into everyday clinical practice. As such, IT provides encouraging mid-term functional outcomes with improved health-related quality of life (QoL), particularly in terms of better preservation of ejaculation. The distinct role IT could play as a bridge between exhausted drug-based treatment options and surgery is yet to be defined. Further studies are required before IT can be recommended as alternatives to invasive therapies. Systematic trials are needed to identify subgroups of patients who can benefit particularly from IT in comparison to other treatments, to identify features of the prostate particularly suited to a specific IT, and to analyze the durability of success for each technique.


Mechanical procedures

*Transurethral incision of the prostate (TUIP)

*
Prostatic urethral lift (UroLif®)

*
Temporary implantable nitinol device (iTIND®)



Ablative procedures

*Convective water vapor energy ablation (Rezum®)

*
Aquablation (AquaBeam®)


Endovascular procedures

*Prostate artery embolization (PAE)




Conclusions for clinical practice

-Due to the variety of current benign prostatic hyperplasia treatment options, targeted patient selection and comprehensive information about all available options is mandatory.

-In addition to the predictive ability of questionnaires and urodynamic measures,
prostate imaging is of great clinical importance, specifically for estimating treatment responses.

-Interventional therapies (IT) have been developed with the aim of decreasing invasiveness, morbidity, and dysfunction related to standard surgical procedures, with a major focus on the preservation of erectile function and antegrade ejaculation.

-Both mechanical IT (UroLif® and iTIND®) can be used under local anesthesia or analgosedation. They have a good safety profile and achieve improvement of lower urinary tract symptoms and functional parameters, although the improvement of the latter is less than with transurethral resection of the prostate (TURP). According to previous studies, both erectile function and antegrade ejaculation can be maintained in both procedures.

-Both water-assisted ablation methods (AquaBeam® and Rezum®) can be considered promising. They seem to be suitable for a wide range of patients who can maintain sexual function with a low rate of complications. For an unambiguous evaluation of steam therapy, prospective studies should be awaited to compare it with established standard procedures. There is still a lack of postoperative long-term data for clear evaluation of aquablation.


-Prostate artery embolization (PAE) is an interventional radiologic procedure with high technical success rates and a good safety profile. However, the deobstructive results of PAE are, similar to the mechanical IT and water-based ablation methods mentioned above, inferior to TURP. Current evidence suggests that PAE has a proportionally greater effect on storage symptoms, including nocturia, than surgical therapies. Predictors of a better clinical outcome after PAE are younger age (<65 years), baseline IPSS between 8 and 25, and the presence of acute urinary retention. PAE is not a substitute for established surgical procedures for severe obstructions, but rather a bridge between exhausted drug-based treatment options and surgery in patients with moderate to severe symptoms. PAE does not exclude a later surgical intervention in case of disease progression, which is why it should also be seen as a supplement to established therapeutic strategies.
 

Attachments

Last edited by a moderator:
Defy Medical TRT clinic doctor

madman

Super Moderator
For many minimally invasive surgical therapies, the size of the prostate and the presence of a median lobe is crucial (Table 1).
Screenshot (1).png
 

madman

Super Moderator
Screenshot (2).png

Fig. 1 A 61-year-old patient with pronounced lower urinary tract symptoms (LUTS; International Prostate Symptoms Score 27), severely impaired quality of life (“very dissatisfied”), and no relevant impairment of erectile function (International Index of Erectile Function 23). The patient desired a treatment that would not interfere with ejaculation; thus, a UroLift® (Pleasanton, CA, USA) was initially performed. One year later, LUTS had not improved and the patient was admitted for prostate artery embolization. a Diagnostic MRI (coronal T2-weighted) shows clear protrusion of the prostate into the bladder (intravesical prostate protrusion marked with a red arrow). b Projection radiography shows the UroLift® anchors in the prostate
 
Last edited:

madman

Super Moderator
Screenshot (3).png

Fig. 8 Before the actual embolization, pretherapeutic simulation is performed to confirm the optimal position of the microcatheter. Selective contrast-enhanced cone beam computed tomography (CBCT) increases the safety of embolotherapy by excluding contrast outside the target region. a CBCT is first performed on one side (e.g., right), then on the other side (left). b In the second CBCT, the persistent contrast on the first side can be clearly seen. c Embolotherapy is then performed under fluoroscopic control
 

madman

Super Moderator
Screenshot (4).png

Fig. 3 a In imaging follow-up, devascularization of the embolized areas can be seen after only a few days (yellow arrow). b In the control after 6 months, almost complete shrinkage of the intravesical prostate protrusion is clearly visible (green arrow). Similarly, the leading clinical complaints (urgency from 4 to 1; nocturia from 6–7 to 1) and quality of life (“satisfied”) have improved significantly
 

Blackhawk

Member
With the size of my prostate, I have those MIST limitations. Urolift has been ruled out, and by a uro who specializes in it, rezum is deemed inadequate though my prostate is still under the limit designated in this study. I am not ready for anything more radical yet, and low dose cialis is helping (I could not tolerate Alfuzosin).

Other treaments apparently very effective though harder to come by are HOLEP, and in vogue in Europe for quite some time, and up and coming in the US is TULSA PRO

Some procedures complicate the possibility for future other procedures. Complex decisions when it actually comes time for these kinds of interventional treatments.
 

FlipFlops

New Member
BetaSitoserol and Saw Palmetto (oil??) - any recomendations on what brand? What is the protocol for treating BPH here. I searched an read as much as I could. Saw people using antibiotics, LEF supplement for prostate, and Curcumin 1G x 2 a day, to using finasteride (risky). Anything else supplmental and/or RX?
 

Nelson Vergel

Founder, ExcelMale.com
Here is a good review of supplements for BPH

 

FlipFlops

New Member

TucsonJJ

Active Member
BetaSitoserol and Saw Palmetto (oil??) - any recomendations on what brand? What is the protocol for treating BPH here. I searched an read as much as I could. Saw people using antibiotics, LEF supplement for prostate, and Curcumin 1G x 2 a day, to using finasteride (risky). Anything else supplmental and/or RX?
I had very little improvement with BetaSitoserol and Saw Palmetto... never heard of LEF. had some improvement with Saw Palmetto extract and Pygeum... didn't help for long, now on caths. Been having bad uro-problems for 40 year though... am considering a Urolift or TUIP.
You might get your estradiol and SHBG checked... high levels can cause prostate enlargment... so can, of course... low T
 

Nelson Vergel

Founder, ExcelMale.com
Buy Lab Tests Online

Sponsors

bodybuilder test discounted labs
Defy Medical TRT clinic
nelson vergel coaching for men
Discounted Labs
TRT in UK Balance my hormones
Testosterone books nelson vergel
Register on ExcelMale.com
Trimix HCG Offer Excelmale
Thumos USA men's mentoring and coaching
Testosterone TRT HRT Doctor Near Me
how to save your marriage

Online statistics

Members online
8
Guests online
6
Total visitors
14

Latest posts

Top