Emerging, newly-approved treatments for lower urinary tract symptoms secondary to benign prostatic hypertrophy

Abstract

Introduction: Oral therapy with alpha-blockers or 5-alpha reductase inhibitors remains the most common treatment in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH). For patients who progress or fail medical therapy, the standard of care surgical treatment continues to be transurethral resection of the prostate (TURP), which has long-studied and durable outcomes. Emerging, minimally invasive options for LUTS secondary to the BPH, however, have been developed over the last decade with promising results and minimal side effects typically associated with TURP, such as retrograde ejaculation and erectile dysfunction.

Materials and methods: We performed a literature review on PubMed over the last 10 years using keywords such as 'lower urinary tract symptoms,' 'benign prostatic hypertrophy,' 'minimally invasive,' and 'outpatient.' All relevant studies that reported on important urinary endpoints were included for each newly-approved treatment option. Available literature across varying prostate volumes was presented.

Results: Newly-approved therapies for BPH include new thermal energy sources (Rezum, aquablation), mechanical stenting (UroLift), prostate artery embolization, and injectable agents. These emerging techniques could be considered in patients where preservation of sexual function is a priority since they have demonstrated comparable urinary outcomes to medical therapy while causing no significant sexual dysfunction. Only prostate artery embolization has been extensively analyzed and proven efficacious in patients with > 80 g prostates who cannot undergo surgery.

Conclusion: We have summarized the newly-approved treatment options for men with LUTS secondary to BPH as an alternative to traditional medical or surgical therapy. As more minimally invasive, office-based technologies emerge, physician and patients will have the ability to choose a treatment that is more catered to patient expectations.