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Review
. 2021 Feb 24:26:72-82.
doi: 10.1016/j.euros.2021.02.001. eCollection 2021 Apr.

Newer Minimally Invasive Treatment Modalities to Treat Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia

Philipp Dahm  1 , Roderick MacDonald  1 , Lauren McKenzie  1 , Jae Hung Jung  2 , Nancy Greer  1 , Timothy Wilt  1
Affiliations
Review

Newer Minimally Invasive Treatment Modalities to Treat Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia

Philipp Dahm et al. Eur Urol Open Sci. .

Abstract

Context: Several newer device-based procedures have recently become available for treating men with lower urinary tract symptoms attributed to benign prostatic hyperplasia, but their effectiveness remains uncertain.

Objective: To assess the longer-term comparative effectiveness (defined as >12 mo of follow-up) of the newer treatment modalities prostatic urethral lift (PUL), transurethral prostate convective radiofrequency water vapor (Rezūm), Aquablation, and prostatic arterial embolization (PAE).

Evidence acquisition: Ovid Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Agency for Healthcare Research and Quality databases were searched through September 30, 2019; hand searches of references of relevant studies were also performed. Eligible studies were randomized controlled trials (RCTs) published in English language. We excluded observational studies.

Evidence synthesis: One RCT (n = 91) found that patients undergoing PUL may be less likely to respond (risk ratio [RR] 0.8; 95% confidence interval [CI] 0.7-1.0; low certainty of evidence [CoE]) and have a higher mean International Prostate Symptom Score (IPSS; mean difference 6.1; 95% CI 2.2-10.0; low CoE) than those undergoing transurethral resection of the prostate (TURP). Among patients undergoing PAE, one small RCT (n = 30) reported similar IPSS response rates (RR 0.9; 95% CI 0.7-1.1; low CoE) and one trial (n = 107) found similar mean IPSS (-0.7; 95% CI -1.3 to 2.7; moderate CoE) scores to those among patients undergoing TURP. A single study on Aquablation reported 12 mo of follow-up only, and a single 3-mo trial compared Rezūm with sham treatment.

Conclusions: The current best evidence underlying these newer therapies is limited to few trials (PUL and PAE), short-term follow-up of 12 mo (Aquablation and Rezūm), or sham comparison only (Rezūm).

Patient summary: Evidence for four of the newer surgical treatments for men with an enlarged prostate is limited to few small trials with short-term follow-up; only one trial compared a new treatment modality with sham surgery.

Keywords: Benign prostatic hyperplasia; Comparative effectiveness; Lower urinary tract symptoms; Randomized trials; Systematic review.

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Figures

Fig. 1
Fig. 1
Flowchart.
Fig. 2
Fig. 2
Risk of bias of included studies. AEs = adverse events; IPSS = International Prostate Symptom Score; QoL = quality of life.
See this image and copyright information in PMC

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