Minimally Invasive BPH/LUTS Surgeries: Are They Worthy of Attention Over Medical Therapy?

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Although an age-related complication, benign prostatic hyperplasia (BPH) is prevalent in 8% of men as young as 31–40 years.^1,2 It can clinically manifest as lower urinary tract symptoms (LUTS), e.g., nocturia, urgency, frequency, urinary retention, weak urinary stream, etc.² Both medical and surgical treatments are available for BPH/LUTS treatment.³ Prostate surgeries can lead to bleeding, urinary tract infections, strictures, and incontinence; and there has been a gradual decrease in surgical treatments compared to medical treatment for BPH.^4–9 On the other hand, diverse BPH/LUTS profiles and complications require a plethora of medications, and, at times, patients cannot tolerate medical therapy, eventually requiring further evaluations and considerations of surgical interventions.^10–14

For this, minimally invasive surgical procedures, including prostatic urethral lift (UroLift^®), Rezum^™, and temporarily implanted nitinol device (iTIND^™) have specific advantages.^15–17 For example, UroLift^® can be performed in the doctor’s office under local anesthesia, facilitates faster recovery time and preserves sexual function.¹⁵ Rezum^™ has shorter procedure time and can be performed as a day-case procedure in outpatient settings while also being cost-effective.¹⁶ Similarly, iTIND^™ does not need anesthesia, can be performed in ambulatory settings, and preserves sexual function and key anatomical structures.¹⁷

Conclusion

Minimally invasive surgeries provide ease of performance with local anesthesia at the doctor’s office while having shorter procedure times.^15–17 They can also preserve sexual function and, hence, can be the choice of treatment in the future.^15–17

CTA: Let us learn from the expert, Dr. V Surya Prakash, and delve into comparison of medical and surgical treatment for BPH/LUTS profiles.

References ▼

1. Lim KB. Epidemiology of clinical benign prostatic hyperplasia. Asian J Urol. 2017;4(3):148–151.
2. Bortnick E, Brown C, Simma-Chiang V, et al. Modern best practice in the management of benign prostatic hyperplasia in the elderly. Ther Adv Urol. 2020;12:1756287220929486.
3. Suarez-Ibarrola R, Miernik A, Gratzke C, et al. Reasons for new MIS. Let's be fair: iTIND, Urolift and Rezūm. World J Urol. 2021;39(7):2315–2327.
4. Lynch M, Sriprasad S, Subramonian K, et al. Postoperative haemorrhage following transurethral resection of the prostate (TURP) and photoselective vaporisation of the prostate (PVP). Ann R Coll Surg Engl. 2010;92(7):555–558.
5. Amu OC, Affusim EA, Mbadiwe O, et al. Postoperative incidence of symptomatic urinary tract infection (UTI) and microbial pattern seen in TURP patients with negative cultures preoperatively. EJMHS. 2024;6(1):84–87.
6. Kore RN. Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasia: A single-center experience. Asian J Urol. 2023;10(2):137–143.
7. Bruschini H, Simonetti R, Antunes AA, et al. Urinary incontinence following surgery for BPH: The role of aging on the incidence of bladder dysfunction. Int Braz J Urol. 2011;37:380–387.
8. Foé CM, Liao Y, Zhang G. A review on urinary incontinence after surgery for benign prostatic hyperplasia. Open J Urol. 2022;12(3):169–184.
9. Kim DK, Park JJ, Yang WJ, et al. Changes in diagnosis rate and treatment trends of benign prostatic hyperplasia in Korea: A nationwide population-based cohort study. Prostate Int. 2021;9(4):215–220.
10. Yan H, Zong H, Cui Y, et al. The efficacy of PDE5 inhibitors alone or in combination with alpha‐blockers for the treatment of erectile dysfunction and lower urinary tract symptoms due to benign prostatic hyperplasia: A systematic review and meta‐analysis. JSM. 2014;11(6):1539–1545.
11. Haddad A, Jabbour M, Bulbul M. Phosphodiesterase type 5 inhibitors for treating erectile dysfunction and lower urinary tract symptoms secondary to benign prostatic hyperplasia: A comprehensive review. Arab J Urol. 2015;13(3):155–161.
12. Jackson EM, Khooblall P, Lundy SD, et al. A review of combined phosphodiesterase-5-inhibitors and α-blockers versus phosphodiesterase-5-inhibitors alone for lower urinary tract symptoms due to benign prostatic hyperplasia. Arab J Urol. 2024;22(1):13–23.
13. Jiwrajka M, Yaxley W, Ranasinghe S, et al. Drugs for benign prostatic hypertrophy. Aust Prescr. 2018;41(5):150–153.
14. Ng M, Leslie SW, Baradhi KM. Benign prostatic hyperplasia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available at: https://www.ncbi.nlm.nih.gov/books/NBK558920/. Accessed on: 17 October 2024.
15. Denisenko A, Somani B, Agrawal V. Recent advances in UroLift: A comprehensive overview. Turk J Urol. 2022;48(1):11–16.
16. Westwood J, Geraghty R, Jones P, et al. Rezum: A new transurethral water vapour therapy for benign prostatic hyperplasia. Ther Adv Urol. 2018;10(11):327–333.
17. Balakrishnan D, Jones P, Somani BK. iTIND: The second-generation temporary implantable nitinol device for minimally invasive treatment of benign prostatic hyperplasia. Ther Adv Urol. 2020;12:1756287220934355.

LMRC CODE: GGI-CO-A1-AQS-300020632-BANNERS-J24-0654

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