Benign Prostatic Hyperplasia

Both the LUTS/BPH and testicular cancer guidelines were updated based on the availability of new literature, as identified through an AUA Update Literature Review process.

"The findings suggest that we may need to view urinary symptoms differently, possibly with an emphasis on earlier treatment,” says Blayne Welk, MD, FRCSC, MSc.

Questions spanned urologic conditions such as benign prostatic hyperplasia, overactive bladder, erectile dysfunction, kidney stones, Peyronie disease, and recurrent urinary tract infections.

“Aquablation is safe and effective based on several years of research,” said urologist Zein K. Nakhoda, MD.

In this installment, Kevin Zorn, MD, FRCSC, FACS, highlights his disease-specific practice, BPH Canada, which he designates as a “one-stop shop” for patients with benign prostatic hyperplasia.

Aquablation is a “minimally invasive procedure [that] is safe with long-term durability and a low-side effect profile,” said urologist Dennis Bentley, MD.

"The next-generation Optilume BPH Catheter System offers a safe and effective new, minimally invasive treatment for BPH, reducing urinary obstruction with a low rate of sexual or other adverse effects," says Steven A. Kaplan, MD.

Data among patients with follow-up of greater than 48 months demonstrated an IPSS reduction of 45.2% from baseline to 79 months following treatment.

The minimally invasive surgical therapy Optilume was recently approved by the FDA for the treatment of lower urinary tract symptoms secondary to BPH.

Data showed a decrease in patient symptoms following Aquablation procedures, with an average IPSS of 22.6 at baseline compared with 6.8 at 5-year follow-up.

The minimally invasive surgical therapy is approved for the treatment of lower urinary tract symptoms secondary to BPH.

"One of the things that made a difference, at least in my practice, was one of the newer pulse modulated holmium lasers," says Smita De, MD, PhD.

"Since transforming the BPH market, Aquablation has as given a degree of confidence for the surgeon as well as for the patient," says Ravi Munver, MD.

“Our data show that low T is an independent risk factor for adverse peri-op outcomes after transurethral prostate surgery,” says Jasmine Lin, MD.

“Surprisingly, testosterone was not independently associated with frailty on our analysis, but on multivariable analysis, both hospital frailty risk score and low preoperative T were independently associated with 180-day readmission,” says Jasmine Lin, MD.

"In the last couple of years, there have been at least 2 sets of great tissue simulators that have come out, and I think they're really providing an opportunity for learning HoLEP," says Smita De, MD, PhD.

The investigators retrospectively analyzed ABU case log data on 8 different BPH surgical procedures ranging from 2008 to 2021.

“This study shows prostate artery embolization to be a safe and highly effective treatment whose long-term outcomes include sustained LUTS relief, significant improvement in quality of life and no change in erectile function,” according to Shivank Bhatia, MD.

“Improved quality of life is the key benefit for our BPH patients," says Scott Barkin, DO.

The new payment rate goes into effect January 2023 and will expand access to care for Medicare beneficiaries.

As the year comes to a close, we revisit some of this year’s top content on benign prostatic hyperplasia.

In this installment of Urology Times’ 50th Anniversary Innovation Celebration, Bradley Gill, MD, MS, discusses the impact that the new wave of minimally invasive BPH treatments has had for both patients and urologists.

“For practicing urologists, I think it's important for us to recognize that when it comes to these techniques, even with Rezum, there's a variety of ways of doing them," says Bilal Chughtai, MD.

“It’s pretty clear that over the past 50 years we've seen innovations in BPH treatment both from the utilization of technology and also from the patient outcome and experience standpoint,” says Bradley Gill, MD, MS.

“We found that the adverse event rates have dropped dramatically, to about a third of what it was reported in the pivotal trial, but at the same time still had the same net benefits in terms of efficacy when it comes to Q max, symptomatic improvement, as well as PVR," said Bilal Chughtai, MD.

Watch Amy E. Krambeck, MD, perform holmium laser enucleation of the prostate (HoLEP) for the treatment of lower urinary tract symptoms related to benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) was defined as prostate size ≥ 40 g, an International Prostate Symptom Index Score ≥ 8, or using BPH medications.

"Aquablation therapy is as effective as other minimally invasive treatments [for these men] but with fewer side effects, including only a 10% to 15% risk of retrograde ejaculation," said Ravi Munver, MD.

“We’re in the process of following patients who have taken saw palmetto extract and tracking their clinical diagnosis,” says Bilal Chughtai, MD.

"It’s the most satisfying of all the things I do as a surgeon. The benefits are so dramatic and often immediate," said Daniel Kellner, MD.