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.
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.
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