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.

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.

"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.

Minimally invasive BPH procedures relieve symptoms and can be done in outpatient settings.

"Too often, men will stay silent about the symptoms they are experiencing from an enlarged prostate that hamper their day-to-day lives," said Dean Elterman, MD.

"The ProVee System has the potential to be an effective treatment for BPH that can be safely and reliably performed in the office setting," according to Steve Kaplan, MD.

In this installment, Howard B. Goldman, MD, FACS, discusses the development of multichannel urodynamics testing.

“For clinicians, the analyses show that moderate and severe male LUTS in general are good indicators of poor health," the authors wrote.

It was previously reported that UroLift received reimbursement approval from the Central Social Insurance Medical Council of Japan (Chuikyo).

“Patients need to understand that even if you tell them that you may be doing this as an ambulatory procedure, they may actually have to stay afterwards, depending on what you find in the operating room or what happens in the postoperative period,” says Michael A. Palese, MD.

"Although it might be easier to enumerate the cancer conditions, in the benign world, struggles continue to overcome patients challenged with these conditions," writes Gopal H. Badlani, MD.

"We shouldn't outright provide a negative attitude to our patients who are looking for alternatives that [serve as] complementary medicine, [like] herbal or phytotherapeutic agents," says J. Curtis Nickel, MD, FRCSC.

"Overall, these findings tell us that not everyone can undergo a same-day surgery for BPH," says Michael A. Palese, MD.

5-year results from the pivotal WATER trial showed IPSS improvement was greater with Aquablation compared with TURP.

“There's no question that many patients [undergoing transurethral BPH surgery] can be done as a same-day ambulatory procedure. But you need to look at the criteria as to who you're going to keep and who you're not going to keep,” says Michael A. Palese, MD.

“I think it's important for urologists and physicians to have an open mind in regard to complementary approaches to the treatment of BPH-related LUTS in men,” says J. Curtis Nickel, MD, FRCSC.

“The overall evidence in the global world literature is that saw palmetto can be effective,” says J. Curtis Nickel, MD, FRCSC.

“What's interesting in Dr Strum's analysis of these trials is that he not only looked at the English literature, which many of us are familiar with, but he looked at the many studies done in countries that were published in the non-English literature and never found [their] way into any of our analyses,” says J. Curtis Nickel, MD, FRCSC.

“I think now the government has realized…the work that’s involved in this procedure…[and] we’re now being reimbursed at an appropriate level,” says David M. Albala, MD.

J. Curtis Nickel, MD, FRCSC, discusses the origins of saw palmetto as an herbal therapy and how it was developed to treat lower urinary tract symptoms.

"The devices, telemedicine and remote care, and outpatient surgery risk us losing the human connection we had with the patient, as time spent with them is at a premium today," writes Gopal H. Badlani, MD.

“I think this really now suggests that Rezum is a financially viable procedure across these different treatment settings…the reimbursement now is really quite favorable,” says David M. Albala, MD.

Expert perspective on the treatment landscape of benign prostatic hyperplasia and lower urinary tract symptoms.

In a recent interview, Kevin T. McVary, MD, FACS, suggested that more physicians should take the time to educate their themselves and their patients on enlargement of the prostate.

In a recent study, Michael Palese, MD, Evan Garden, and co-authors estimated the long-term outcomes of Rezum water vapor therapy in treating men with large prostates who have benign prostatic hyperplasia.

The once-daily capsule combines 5 mg of tadalafil with 5 mg of finasteride.

“While this study does offer a lot of promise for the treatment options that we can offer to these patients, it does also highlight the need for further prospective trials to evaluate the efficacy of this treatment, as well as the treatments of all the different surgical options available to patients who are suffering from BPH,” says Evan Garden.

“I think the key elements are that you should know about Aquablation if you are treating BPH in consideration for your patients and care, especially those who are looking for a more durable response and to maintain their ejaculation,” says Kevin Zorn, MD, FRCSC, FACS.

“Compared to other BPH treatments, this is a very fast, reproducible technology that could democratize how all urologists do BPH surgery,” says Kevin Zorn, MD, FRCSC, FACS.