Minimally invasive techniques for the treatment of benign prostatic hyperplasia

João Arthur Brunhara Alves Barbosa, Alberto Azoubel Antunes
2018 Revista de Medicina  
Benign Prostatic Hyperplasia (BPH) occurs in up to 80% of men older than 70 years. The prevalence of BPH increases with age, from approximately 25% of men at 50 years of age to 50 to 90% of individuals in their 8th decade of life. Treatment options for lower urinary tract symptoms (LUTS) secondary to BPH have been long restricted to drug therapy and, after failure of the former, surgical treatment. However, prostate surgery is associated with risks such as bleeding, necessity of transfusion and
more » ... ejaculatory dysfunction. Several novel and minimally invasive methods for treatment of BPH have arisen in the past years. Common to all of these techniques are a more favorable safety profile and varying rates of success and clinical improvement, however frequently inferior to standard surgical techniques. Patients who will benefit the most from these procedures are those who would not wish to undergo surgery, those at prohibitively high risk for surgery, and those wishing to avoid ejaculatory dysfunction secondary to trans-urethral resection of the prostate (TURP) or open resection. Mechanical devices such as Temporary implantable nitinol device and Urolift appear to provide satisfying results with a favorable safety profile. Persistence of improvement is still questionable since follow-up longer than 5 years is not available for these methods. Of note, these methods may be of limited performance for larger prostates, in special, Urolift for those with a large median lobe or a prostate larger than 100 grams. Similarly, novel techniques for tissue ablation, including convective water vapor energy, appear to offer promising and safe results, yet with limited follow-up. Prostate artery embolization (PAE) is another safe procedure and an option for patients who are not suited for surgery, with satisfying short and medium-term follow-up but unknown results at long-term.
doi:10.11606/issn.1679-9836.v97i3p314-319 fatcat:aqmh4ejk6ngrbgyt63z7ryon5m