Benign Prostatic Hyperplasia

In this second iteration of a 3-part series, Shawn H. Marhamati, MD, MS, highlights the experiences and data that supported the trial of Aquablation in an ASC setting.

In this first video of a 3-part series, Shawn H. Marhamati, MD, MS discusses a pilot trial of Aquablation in an ASC setting and highlights the benefits of the therapy.

iTind is a temporary nitinol device used to treat lower urinary tract symptoms caused by benign prostatic hyperplasia.

"I don't think anybody, at least in our Mayo Clinic practices, is ever doing anything other than apical release HoLEPs these days," says Daniel J. Heidenberg, MD.

"But I think that this really showed us that the outcomes were substantially better than I think any of us were thinking," says Daniel J. Heidenberg, MD.

Dr. Heidenberg discusses the recent Urology paper, “The Impact of Standard vs Early Apical Release HoLEP Technique on Postoperative Incontinence and Quality of Life.”

“The UroLift 2 ATC is designed to deliver the same proven effectiveness of the UroLift System, with significant enhancements on a unified UroLift 2 platform,” says Brian Wilkins.

"We really aimed to affect 3 different contraindications and instead achieved retirement of the entire policy, which, we think, really opens up this wonderful technology to literally hundreds of thousands more patients across the country," says Arpeet Shah, MD.

“We're always so focused on the prostate. That's the million-dollar question: are we getting to bladders too late?” says Kevin C. Zorn, MD, FRCSC, FACS.

“It's exciting to see that we now have another offering to men with enlarged prostates that has good outcomes and good durability up to 5 years [based on] the trials,” Kevin C. Zorn, MD, FRCSC, FACS.

"The ProVee System has the potential to be a first-line interventional therapy for BPH that can be safely and reliably performed in the office setting," says Steven A. Kaplan, MD.

"I think it's important that they go visit someone that does them. Go to the operating room, see it in person," says Matthew E. Sterling, MD.

“These are the technologies that we'll see to empower patients and get more information, so that when we see the patient, it's one less thing we as a physician have to gather during that consultation, making the consultation more efficient,” says Kevin C. Zorn, MD, FRCSC, FACS.

"Some of it actually is self-selecting because people are hearing about it more and come in asking about it first," says Brian Friel, MD.

"The learning curve is fairly quick; you can pick this up pretty easily vs some of the other prostate procedures that can take a little bit more time to learn how to use," says Matthew E. Sterling, MD.

"The limitation of [TURP] is you're shaving out prostate tissue in a layer at a time, and you stop when you think you're deep enough, whereas with an Aquablation, you map all that out ahead of time," says Brian Friel, MD.

Kevin M. Wymer, MD, shares the take-home messages from the recent Urology paper, “Evaluation of Private Payer and Patient Out of Pocket Costs Associated with the Surgical Management of Benign Prostatic Hyperplasia.”

"I think, importantly, when we look at comparing BPH surgical intervention options, we should not only factor in clinical outcomes and clinical differences, but also in the setting of our current health system, cost is becoming increasingly important," says Kevin M. Wymer, MD.

“Overall, I'd say these shorter-term outcomes at 6 months look to be very similar to those outcomes measured with the smaller glands. In a sense, at least within this range, volume may not be a deal breaker,” says Kevin T. McVary, MD.

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

“There's a bit of an unmet need about the impact of Rezum in these bigger prostates,” says Kevin T. McVary, MD.

All patients had prostates greater than 80 mL and had not responded to prior medication therapy.

The center will offer a comprehensive range of treatments, including prostate artery embolization for men suffering from benign prostatic hyperplasia with very large prostates.

“It's 2023. We have a lot of other options. I'm not really sure that would be my frontline therapy for my dad or a family member,” says Kevin C. Zorn, MD, FRCSC, FACS.

Support for the NICE recommendation included 5-year results from the WATER trial, which showed that Aquablation had strong efficacy and safety vs transurethral resection of the prostate in patients with BPH.

The inclusion of iTind is reflected in a newly added statement on temporary implanted prostatic devices.

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.