Concept: Transurethral microwave thermotherapy
To report 3-year outcomes of a prospective, multi-center, randomized, blinded control trial after treatment with convective radiofrequency (RF) water vapor thermal therapy for moderate to severe lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).
This report evaluates clinical experience with the Rezūm system after US Food and Drug Administration clearance in consecutive cases accrued by multiple community urologists for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Treatment techniques for transurethral convective radiofrequency water-vapor thermal therapy and outcomes with up to 12 months' follow-up are presented.
Benign prostatic hyperplasia (BPH) and its associated lower urinary tract symptoms (LUTS), including nocturia, are extremely common among middle- and older-aged American men. While studies of physical activity (PA) and prevalent BPH-related outcomes suggest that PA may protect against the development of this common condition, only a few studies have examined the relation between PA and incident BPH-related outcomes and LUTS with mixed findings. Additionally, although nocturia is the most commonly reported and most bothersome LUTS in men with or without evidence of BPH, few studies have examined the association of PA and nocturia independent of BPH. The purpose of this analysis was to examine the association of PA with BPH-related outcomes and nocturia in the PLCO Trial.
What’s known on the subject? and What does the study add? Transurethral resection of the prostate (TURP) remains the dominant and definitive treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS-BPH), but the widespread use of medical therapies (particularly monotherapies) for rapid symptom improvement has meant that the most common indication for TURP has shifted to moderate-severe medical therapy refractory LUTS to, coupled with abnormal objective parameters, or when complications arise. Patients undergoing TURP as part of contemporary randomised controlled trials are not older but have a larger preoperative prostate volume and reduced major morbidity compared with large cohort studies from successive past eras. Delayed surgery because of prolonged medical monotherapy may explain a higher reported failure to void rate, possibly because of negative impact on detrusor function from unrelieved obstruction. This study examined contemporary TURP for significant changes, specifically regarding prostate size, operative parameters, and outcomes, compared with two preceding decades. Electronic databases PubMed, EMBASE & Cochrane collaboration were searched for English literature on prospective randomized controlled trials, published between 1997 and 2007 using keywords “transurethral resection” and “prostate”. Monopolar TURP (M-TURP) cohort data of each study were selectively pooled for analysis, weighting studies according to patient numbers. Where possible, pooled post-operative outcomes data were compared with two large cohort landmark studies of successive preceding decades. A total of 3470 patients from 67 studies were included. Mean patient age (67 years) was unchanged, while mean pre-operative prostate volume of 47.6 g was greater than previously reported. Mean resected prostate tissue (25.8 g) with a resection time of 38.5 minutes suggested improved resection efficiency. A statistically significantly reduced transfusion rate and increased urinary tract infection (UTI) rate were reported. Hospital stay (3.6 days) and initial catheterisation duration (2.5 days) were similar, but post-operative urinary retention rate was slightly higher (6.8%). Contemporary RCTs of M-TURP showed larger prostate volume, and reduced major morbidity, compared with large cohort studies from successive past eras. The higher reported failure to void rate, may possibly reflect worse detrusor function at time of TURP. Delaying surgery by prolonged medical monotherapy may compound this. Trials methodology in this area requires quality improvement and standardisation in future.
WHAT’S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Despite high morbidities, TURP is still considered as the ‘gold standard’ for treatment of BPH. Photoselective vaporization of the prostate (PVP) is a promising technique that is emerging as a possible alternative to TURP. However, there remains some debate about the advantages of PVP over TURP and whether PVP will be able to replace TURP as the first-line surgical treatment. We conducted a meta-analysis of recent papers on this subject and herein provide the overall efficacy and safety of PVP for treatment of BPH. OBJECTIVE: To assess the overall efficacy and safety of photoselective vaporization of the prostate (PVP) vs transurethral resection of the prostate (TURP) for treating patients with lower urinary tract symptoms (LUTS) secondary to benign prostate hyperplasia (BPH). PATIENTS AND METHODS: A systematic search of the electronic databases, including MEDLINE, Embase, Web of Science and The Cochrane Library, as well as manual bibliography searches were performed. The pooled estimates of maximum flow rate (Q(max) ), postvoid residual (PVR), quality of life (QoL), International Prostate Symptom Score (IPSS), operation duration, blood loss, catheterization time, hospital stay, capsule perforation, transfusion, transurethral resection (TUR) syndrome, urethral stricture and reintervention were calculated. RESULTS: At the 3-month follow-up, there was no significant difference in Q(max) , PVR, QoL and IPSS between the TURP and PVP groups. At the 6-month follow-up, the pooled QoL favoured TURP, but there was no significant difference in the other variables between the two groups. PVP was associated with less blood loss, transfusion, capsular perforation, TUR syndrome, shorter catheterization time and hospital stay, but longer operation duration and higher reintervention rate. CONCLUSIONS: The efficacy of PVP was similar to that of TURP in relation to Q(max) , PVR, QoL and IPSS, and it offered several advantages over TURP. As a promising minimal invasive technique, PVP could be used as an alternative surgical procedure for treating BPH.
To compare clinical and urodynamic results of transurethral resection of the prostate (TURP) to original and PErFecTED prostate artery embolization (PAE) methods for benign prostatic hyperplasia.
Chronic prostatic inflammation is implicated in the pathogenesis of benign prostatic hyperplasia (BPH)-associated lower urinary tract symptoms (LUTS). Previous studies evaluated the degree of chronic prostatic inflammation based on histological scores, which may contain subjective factors. We previously demonstrated that the number of high endothelial venule (HEV)-like vessels correlates positively with the magnitude of inflammation in chronic inflammatory gastrointestinal diseases. Here, we evaluated the degree of BPH-associated chronic prostate inflammation based on appearance of HEV-like vessels and determined whether the extent of inflammation correlated with LUTS severity, as evaluated by a urodynamic study.
This evaluation of long-term outcomes of treatment for lower urinary tract symptoms due to benign prostatic hyperplasia compares a one-time water vapor thermal therapy procedure with daily medical therapy in cohorts from the Medical Therapy of Prostatic Symptoms (MTOPS) study.
Transurethral resection of the prostate (TURP) is considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, TURP may lead to sexual dysfunction and incontinence, and has a long recovery period. Prostatic urethral lift (PUL) is a treatment option that may overcome these limitations.
The UK Register of Prostate Embolisation (UK ROPE) study aimed to assess the efficacy and safety of Prostate Artery Embolisation (PAE) for Lower Urinary Tract Symptoms secondary to Benign Prostatic Hyperplasia (LUTS/BPH) patients. The main secondary aim was an indirect comparison with transurethral resection of the prostate (TURP).