To provide an update on novel minimally invasive LUTS/BPH treatments in a non-systematic review. To define potential target populations for the various new minimally invasive treatments.
Recent literature, meta-analyses and guideline recommendations for aquablation (AquaBeam® ), water vapour thermal therapy (Rezūm® ), prostate artery embolization (PAE), prostatic urethral lift (UroLift® ) and the nitinol butterfly-like stent (i-TIND® ) were reviewed.
Procedures that can be performed on an outpatient basis (Rezūm® , PAE, UroLift® and i-TIND® ) are not an alternative for the standard patient requiring BPH surgery. Their effect on uroflow, PVR or bladder outlet obstruction is less pronounced than that of TURP. Yet, these options appear to be valuable for those patients unfit for surgery, men who want to avoid medical therapy in general or those who want to avoid sexual side effects associated with medical therapy or standard BPH surgery (e.g. TURP). Aquablation is the first successfully operationalized robotic resection system, especially for patients with prostates above 50 gm in size. Nevertheless, long-term data are necessary for all novel, minimally invasive treatments.
Better designed clinical trials, a clearer definition of target populations and a more realistic marketing allow a better characterisation of novel minimally invasive therapies for LUTS/BPH. It is hoped that some of these novel devices will stand the test of time, in contrast to the vast majority of their predecessors.
BJU international. 2020 Jun 29 [Epub ahead of print]
Stephan Madersbacher, Claus G Roehrborn, Matthias Oelke
Department of Urology, Kaiser Franz Josef Hospital, Sigmund Freud Private University, Vienna, Austria., Department of Urology, UT Southwestern Medical Center at Dallas, Texas, USA., Department of Urology, St. Antonius Hospital, Gronau, Germany.