3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 Benign prostatic hyperplasia: an update on minimally invasive therapy including Aquablation Akhil K. Das, MD, 1 Timothy M. Han, BA, 1 Alex Uhr, MD, 1 Claus G. Roehrborn, MD 2 1 Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA 2 Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA DAS AK, HAN TM, UHR A, ROEHRBORN CG. Benign prostatic hyperplasia: an update onminimally invasive therapy including Aquablation. Can J Urol 2020;27(Suppl 3):2-10. Introduction: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) is a common condition affecting older men. New interventional treatments have emerged and evolved over the years, each with their own distinct efficacy and safety profiles. While some have fallen out of favor, new options continue to be explored. Materials and methods: We provide a review and update on minimally invasive treatment modalities for BPH, including prostatic artery embolization (PAE), Aquablation, convective water vapor thermal therapy (Rezum), and prostatic urethral lift (Urolift). Results: While current urologic guidelines recommend against PAE outside of the context of clinical trials, Aquablation, Rezum, and Urolift have demonstrated excellent efficacy and durability in relieving LUTS in the BPH patient. When compared to the gold standard, transurethral resection of the prostate (TURP), these novel therapies yield equivalent or superior objective outcomes, with the additional benefit of significantly reduced sexual side effects. Additionally, Rezum and Urolift may be performed as outpatient procedures under local anesthesia, allowing for decreased hospitalizations, operative times, catheterization duration, and financial burden on the health care system. Conclusions: Aquablation, Rezum and Urolift are minimally invasive surgical treatment options capable of providing rapid, significant, and durable relief of LUTS secondary to BPH. Each technique demonstrates comparable efficacy to TURP with the added advantages of preserving sexual function, decreasing patient morbidity, and limiting healthcare costs. Key Words: prostatic arterial embolization (PAE), Urolift, Rezum, Aquablation, benign prostatic hyperplasia (BPH), lower urinary tract symptoms (LUTS), minimally invasive therapy Address correspondence toDr.Akhil K. Das, Thomas Jefferson University, Department of Urology, 1025 Walnut Street, College Building, Suite 1110, Philadelphia, PA 19107 USA Introduction Patients with benign prostatic hyperplasia (BPH) frequently experience significant lower urinary tract symptoms (LUTS), a common myriad of urinary symptoms including urinary frequency, urgency, nocturia, incomplete bladder emptying, or weakened streamthat often results inpresentation to anurologist’s office. While multiple medical therapies exist as first 2 line treatment options, men who continue to have obstructive voiding symptoms, urinary tract infections, kidney injury, persistent prostatic bleeding or bladder stones may require surgical evaluation. Transurethral resection of prostate (TURP) is generally considered the standard of care for surgical management of BPH, but has been associated with both sexual and urinary comorbidities. In an effort tomaximize symptom relief and patient satisfactionwhileminimizing negative side effects such as incontinence and sexual dysfunction (i.e. erectile dysfunction, retrograde ejaculation), multiple novel therapies have been reported. Despite the development and evolution of various treatment