An overview of non-interventional and surgical therapies for benign prostatic hyperplasia

(1) To review and compare the current medical, surgical, and minimally invasive therapies for BPH, including prostatic artery embolization (PAE), Rezum, aquablation, Urolift, and HoLEP. (2) To review and compare other surgical and minimally invasive approaches suggested by the American Urological Association (AUA) guidelines in the context of interventional radiology. (3) To highlight strengths and limitations of each therapy approach with a focus on PAE, Rezum, aquablation, Urolift, and HoLEP.

Background:

Benign prostatic hyperplasia (BPH) affects 80% of men by age 80, leading to significant impact on quality of life. Despite a dearth of medical treatments, there is a diverse landscape of surgical treatments and minimally invasive BPH therapies. Thorough knowledge of the strengths and limitations of each approach is critical to determining the best management strategy and honoring patient goals of care. We seek to provide an overview of the medical therapies, surgical interventions, and minimally invasive approaches for the treatment of BPH and associated lower urinary tract symptoms (LUTS).

Clinical Findings/Procedure Details:

This exhibit will: 

1. Review and compare medical options for BPH treatment, including alpha-adrenergic antagonists (alpha blockers), 5-alpha reductase inhibitors (5ARIs), phosphodiesterase-5 selective inhibitors (PDE5s), anticholinergics, beta-3 agonists, and combination therapies.


2. Review the surgical and minimally invasive therapies with a focus on prostatic artery embolization (PAE), Rezum, Urolift, Aquablation, and HoLEP.


3. Discuss the updated surgical guidelines from the AUA involving transurethral resection of the prostate (TURP), transurethral microwave therapy (TUMT), water vapor thermal therapy (WVTT), transurethral needle ablation (TUNA), laser enucleation, and robotic waterjet treatment (RWT) in the context of interventional radiology.


4. Compare international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), quality of life (QoL), and postvoid residual (PVR) of Rezum, Urolift, Aquablation, PAE, HoLEP, and TURP as well as highlight the strengths and limitations of other approaches (TUMT, WVTT, TUNA, RWT, and laser enucleation).

Knowledge of the various therapy options for LUTS is critical to providing patient-centered care. Each of the therapy options has associated strengths and limitations that should be viewed in the context of a patient’s goals, as these interventions directly impact quality of life.