Minimally invasive devices for treating lower urinary tract symptoms in benign prostate hyperplasia: technology update

Abstract

Benign prostatic hyperplasia (BPH) represents a spectrum of related lower urinary tract symptoms (LUTS). The cost of currently recommended medications and the discontinuation rate due to side effects are significant drawbacks limiting their long-term use in clinical practice. Interventional procedures, considered as the definitive treatment for BPH, carry a significant risk of treatment-related complications in frail patients. These issues have contributed to the emergence of new approaches as alternative options to standard therapies. This paper reviews the recent literature regarding the experimental treatments under investigation and presents the currently available experimental devices and techniques used under local anesthesia for the treatment of LUTS/BPH in the vast majority of cases. Devices for delivery of thermal treatment (microwaves, radiofrequency, high-intensity focused ultrasound, and the Rezum system), mechanical devices (prostatic stent and urethral lift), fractionation of prostatic tissue (histotripsy and aquablation), prostate artery embolization, and intraprostatic drugs are discussed. Evidence for the safety, tolerability, and efficacy of these “minimally invasive procedures” is analyzed.

Efficacy and safety of prostate artery embolization on lower urinary tract symptoms related to benign prostatic hyperplasia: a systematic review and meta-analysis

“…PAE was first utilized in the 1970s to treat refractory bleeding following prostatic interventions as well as for intractable hematuria 15. It demonstrated a successful reduction in PV without serious complications in human beings in 2010 2.…”

Update on minimally invasive surgery and benign prostatic hyperplasia

“…Several reviews on minimally invasive surgical treatments for lower urinary tract symptoms (LUTS) due to BPH have been published within the last 2 years, perhaps an indication of the interest and progress in this dynamic field of surgical device technology [1] , [2] . Transurethral resection of the prostate (TURP) and open simple prostatectomy (OSP) have been the historical reference-standard procedures for decades.…”

Oxidative stress and prostatic diseases

“…Prostate cancer (PCa) is the most prevalent cancer type in males >50 years of age and the second most common cause of cancer-associated mortality in males ( 2 ). Benign prostatic hyperplasia (BPH) represents the most common urologic disorder among elderly men, with ~40% of males >60 years affected ( 3 ). Chronic prostatitis/chronic pelvic pain syndromes (CP/CPPS) are other challenging urology disorders responsible for considerable disability in affected patients ( 4 ).…”