The Surgical Management of BPH and Updates from the AUA Clinical Guidelines

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At the conclusion of this activity, participants will be able to:

1. Describe the role of the AUA Clinical Guideline on the Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia.

2. Discuss the evidence base for current technologies, including pivotal studies, and be able to define the role and clinical expectation for each of them.

3. Interpret the current clinical results and compare the patient experiences of these treatments in relation to more established and even abandoned treatments for patient groups with similar characteristics.

4. Differentiate between each of the new technologies for treating BPH/LUTS based on both their mode-of-action and the quality of their supporting evidence.

The Surgical Management of BPH and Updates from the AUA Clinical Guidelines (2024)​

Introduction

The American Urological Association (AUA) continues to provide invaluable educational resources for the management of benign prostatic hyperplasia (BPH). A recent webinar, "The Surgical Management of BPH and Updates from the AUA Clinical Guidelines (2024)," highlighted current surgical options and guidelines. Accredited for 1.5 AMA PRA Category 1 Credits, the session featured expert insights into various BPH treatments, ensuring that urologists remain updated on the latest advancements and recommendations.

Understanding the Guidelines

Dr. Lori Lerner, the course director, emphasized the importance of the AUA clinical guidelines. These guidelines, developed from extensive clinical trials and randomized control trials, aim to provide evidence-based recommendations for managing male lower urinary tract symptoms secondary to BPH. The panel discussed how these guidelines assist in making informed decisions about patient care, particularly in evaluating prostate size, Euro flow, postvoid residual (PVR) measurement, and pressure flow studies.

Evaluation and Diagnosis

Accurate diagnosis is crucial for effective BPH management. The panel highlighted the significance of prostate sizing, PVR measurement, and Euro flow in diagnosing BPH. Pressure flow studies, both invasive and non-invasive, were also discussed as vital tools for assessing bladder function and deciding on the most appropriate treatment.

Treatment Options

The webinar presented various surgical and minimally invasive treatment options for BPH, each with its unique benefits and considerations.

1. Prostate Artery Embolization (PAE)
   • Overview: PAE is a non-surgical option that reduces symptoms and improves the quality of life by embolizing the prostate artery. It’s particularly suitable for patients with moderate to severe lower urinary tract symptoms.
   • Effectiveness: Studies show that while PAE is effective, its outcomes can be more variable compared to TURP. It offers fewer complications, making it a viable option for many patients.
2. Temporary Implantable Nitinol Device (iTind)
   • Overview: iTind provides significant, rapid, and durable improvement in symptoms with minimal post-operative complications. It is ideal for patients with smaller prostates and a high-riding bladder neck.
   • Patient Benefits: The device preserves sexual function, involves no cutting or permanent implants, and allows for future procedures if needed.
3. Robotic Waterjet Therapy (Aquablation)
   • Overview: Aquablation uses real-time image guidance and high-velocity water jets for precise tissue resection. It is effective for a wide range of prostate sizes and focuses on preserving erectile and ejaculatory functions.
   • Procedure Details: The therapy involves a standardized approach, ensuring consistent outcomes regardless of prostate size. It combines robotic precision with minimal invasiveness.
4. Holmium Laser Enucleation (HoLEP)
   • Overview: HoLEP is a durable, size-independent procedure with low reoperation rates. It combines the minimally invasive nature of TURP with the comprehensive tissue removal of a simple prostatectomy.
   • Advantages: HoLEP offers maximal outlet deobstruction with minimal invasiveness, making it a superior choice for many patients. The use of various lasers (holmium, thulium, green light, etc.) has expanded its applicability.

Patient Selection and Counseling

Effective patient counseling is crucial for setting realistic expectations and ensuring optimal outcomes. The panel stressed the importance of discussing potential side effects, recovery processes, and the possibility of needing secondary procedures or returning to medical therapy. Clear communication helps patients understand their options and make informed decisions about their treatment.

Conclusion

The AUA's commitment to providing up-to-date educational resources is evident in their comprehensive guidelines and webinars. The "Surgical Management of BPH and Updates from the AUA Clinical Guidelines (2024)" session offered valuable insights into various treatment options, helping urologists stay informed and deliver the best possible care to their patients. By understanding the guidelines and evaluating each patient's unique needs, urologists can effectively manage BPH and improve patient outcomes.