Opinion
Video
Resective Surgery and Minimally Invasive Procedures For BPH
Author(s):
A panelist discusses how benign prostatic hyperplasia (BPH) treatment has evolved to include a spectrum of minimally invasive and surgical interventions, ranging from emerging technologies like prostatic urethral lift (PUL) and water vapor thermal therapy (WVTT) to more established resective surgical techniques such as transurethral resection of the prostate (TURP), holmium laser enucleation (HoLEP), Aquablation, and Greenlight XPS, providing urologists with a diverse array of options tailored to individual patient characteristics, prostate size, and specific clinical needs.
Video content above is prompted by the following:
Overview
Management of BPH encompasses a spectrum of interventions ranging from minimally invasive procedures to more extensive surgical techniques. Physicians should consider patient-specific factors such as prostate size, symptom severity, comorbidities, and patient preferences when selecting an appropriate treatment approach.
Minimally Invasive Procedures
Minimally invasive treatments offer reduced procedural risks and faster recovery compared with traditional surgical interventions:
Key Modalities
- PUL:
- Less invasive approach
- Preserves sexual function
- Minimal tissue destruction
- Suitable for smaller prostates
- WVTT:
- Uses controlled thermal energy
- Reduces prostate tissue volume
- Outpatient procedure
- Minimal systemic adverse effects
- Temporary Implantable Nitinol Device (iTIND):
- Mechanical approach to tissue compression
- Temporary implantation
- Potential for reduced surgical trauma
Resective Surgical Procedures
More comprehensive interventions for significant BPH cases:
Established Techniques
- TURP:
- Gold standard surgical intervention
- Effective for medium-sized prostates
- Higher risk of sexual dysfunction
- HoLEP:
- Laser-based technique
- Effective for larger prostates
- Reduced bleeding risk
- Preserves continence
- Aquablation:
- Robotic water jet ablation
- Independent of prostate anatomy
- Potential for reduced thermal damage
- Greenlight XPS:
- Laser-based vaporization
- Rapid tissue ablation
- Suitable for patients on anticoagulants
Clinical Considerations
- Individualize treatment based on:
- Prostate size
- Patient age
- Comorbidities
- Sexual function preservation
- Surgical risk tolerance
- Comprehensive patient counseling
- Thorough preoperative evaluation
- Multidisciplinary approach to management
Conclusion
The evolving landscape of BPH treatments offers physicians multiple options to address patient needs, balancing efficacy, safety, and quality-of-life considerations.
