We got a little MIST-y at this year’s AUA Annual Meeting

Garrett D. Pohlman, MD

Once upon a time, patients seeking interventional treatment for benign prostatic hyperplasia (BPH) were faced with a lifetime of taking daily medication, maybe undergoing a transurethral resection of the prostate, or perhaps a simple open prostatectomy. But today, if you’re one of the millions of men with BPH, there have never been more options for you to get relief from your symptoms.

This notion was immediately apparent at this year’s American Urological Association (AUA) Annual Meeting in Las Vegas, Nevada, in April. From perusing the program agenda to walking through the Science and Technology Hall, minimally invasive surgical techniques (MISTs) were everywhere. I saw attendees crowding around MIST companies’ booths, and it was standing room only in many of the MIST-related podium presentations and educational sessions. And as the Society of Benign Prostatic Disease closed the conference with its meeting, MISTs also made up a large portion of its agenda.

From my perspective, this is great for patients and physicians, because when it comes to BPH treatment, one size definitely does not fit all. When patients come to me seeking relief from their lower urinary tract symptoms, the options we explore are determined by a myriad of factors, such as how big their prostate is. What is unique about their anatomy—is there a median lobe present? Have they had previous BPH interventions? How severe are their symptoms? And so on.

What’s more, at one time, if a patient realized an improvement in their flow rate and a decrease in symptoms, we considered it a success. But today, patients are more vocal than ever and demand options that minimize adverse events—especially ones that negatively affect ejaculatory function. So, treatment options have continued to evolve to now include MIST options that help preserve ejaculatory function and even modified approaches to resection-type BPH interventions to preserve tissue proximal to the verumontanum, with the goal of reducing the rates of impaired ejaculatory function.

It's also apparent that there are different levels of invasiveness when it comes to MISTs, and the definition of minimally invasive can vary from one person to the next. The length of recovery time, a need for postprocedure catheters, and the amount of tissue removed (if there is any removed at all) are all part of the conversation, and those factors can hold different levels of importance, depending on the patient.

So, what’s the main takeaway? For me, flexibility continues to be key. Urologists must remain flexible in their approach to BPH care and stay up to speed on the newest innovations coming to market and the updated clinical data available. Also, I see an ongoing need to continue the conversation about BPH treatment options that actually address the root cause of BPH symptoms: bladder obstruction. Until we start looking at treatment options as fixing the problem and realize that some only act as a Band-Aid, patients will not find true, durable relief.