Benign Prostatic Hyperplasia

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.

“From our standpoint, bigger prostates bleed more…From that, we started taking a different approach for those larger prostates,” says Andrew Higgins, MD.

In a recent study presented at the 2021 SMSNA Fall Scientific Meeting, Kevin J. Campbell, MD, MS, and a team of investigators examined the correlations between finasteride and drugs used to treat hypogonadism and sexual dysfunction in order to understand how best to prescribe this medication in terms of lowering adverse drug reactions.

“Currently, there is no role for statins in management of LUTS,” says Jordan J. Kramer, MD.

“There are a number of significant advantages of this new technology, including the maintenance of antegrade ejaculation, the short operative time [and] the exceptional outcomes postoperatively for the patient,” says Naeem Bhojani, MD, FRCSC.

"If you look at men who had sexual dysfunction at the beginning of the study, compared to men that had good sexual function at the beginning of a study, both groups of men have equal response to improvement in their lower urinary tract symptoms,” says Kevin T. McVary, MD, FACS.

“The idea that Aquablation [treats] any size and any shape of prostate really does seem to hold true for these cohorts of patients,” says Dean Elterman, MD, MSc, FRCSC.

“The main advantages with regard to the Zenflow Spring System are that there's no piercing, there's no trauma, and there's no heat involved with the treatment,” says Peter Chin, MD.

“What we found was [that] every subgroup, whether they were less than or greater than 100 mLs, or whether they had an obstructive median lobe or didn't have a median lobe, [all] showed significant improvements…regardless of their subcategory,” says Dean Elterman, MD, MSc, FRCSC.

Jordan J. Kramer, MD, discusses the background and findings of the study, “Statin use and lower urinary tract symptoms (LUTS) incidence and progression in reduction by dutasteride of prostate cancer events (REDUCE) trial.”

In a recent Journal of Urology study, Jordan J. Kramer, MD, and co-authors examined whether statins impact LUTS incidence in asymptomatic men and progression in symptomatic men with BPH.

“This study was very important in that it showed cost savings with MOSES as well as the ability to reliably achieve same-day discharge,” says Matthew S. Lee, MD.

“Even factoring in the increased number of emergency room visits, there was still an overall cost savings of $747 in favor of the Moses HoLEP. So, that was surprising to see,” says Matthew S. Lee, MD.

“This study really demonstrates, for one of the first times certainly in the largest cohort of men ever [studied], that Rezum water vapor thermal therapy is a viable option to treat men with very large prostates bigger than 80 mL,” says Dean Elterman, MD, MSc, FRCSC.

“The efficiency of the procedure and clear visual opening of the prostatic urethral channel makes the Zenflow [Spring System] an exciting new tool in the treatment for BPH,” said Michael D. Trotter, MD.

“The majority of treatments out there don't allow the maintenance of ejaculation after surgery, whereas here, we're at 90% for the small glands…[and at] 81% [for] the men who had prostates above 80 grams,” says Naeem Bhojani, MD, FRCSC.

“The data is out to about 2 to 3 years now, so…[it’s] a little bit on the immature side, but it's very promising,” says Bilal Chughtai, MD.

In a recent study presented at the 2021 AUA Annual Meeting, Kevin T. McVary, MD, FACS, and co-authors assessed the 5-year outcomes of Rezum water vapor thermal therapy in patients with BPH, specifically focusing on erectile and ejaculatory function.

In a study presented at the 2021 AUA annual meeting, Bilal Chughtai, MD, and co-authors implemented the new iTind system, designed to treat patients with LUTS secondary to BPH by implanting the device via a cystoscopic procedure.

In this interview, Steven A. Kaplan, MD, discusses notable findings from a recent study evaluating multiple BPH treatments as well as his own patient selection process for treatments.

“The Zenflow device is certainly something that…appears to be able to be placed quite easily, seems to be minimally invasive [and] so far seems to be durable,” says Peter Chin, MD.

In a study presented at the 2021 AUA Annual Meeting, Andrew Higgins, MD, and co-authors implemented electrocautery protocols to mitigate blood loss among patients who undergo Aquablation.

“My patient selection process for BPH treatments can be a little bit cumbersome and take time, but that's really because for the first time ever, we have so many different options available to men,” says Dean Elterman, MD, MSc, FRCSC.

“I think Aquablation is safe. It’s efficacious, especially in these large prostates,” says Kevin Zorn, MD, FRCSC, FACS.

“For some men, it's very important to make sure that they have an antegrade ejaculation and this is a treatment modality that we're able to offer them,” says Andrew Higgins, MD.

“What's novel about the iTind system is [that] it's one of the first treatments that [can] be deployed through a flexible cystoscope, as well as the fact that there is no permanent energy or permanent foreign body that's left within the prosthetic urethra,” says Bilal Chughtai, MD.