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Comparing Outcomes of Medical Management and Minimally Invasive Surgical Techniques for Lower Urinary Tract Symptoms due to BPH

  • Benign Prostatic Hyperplasia (K McVary, Section Editor)
  • Published:
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Abstract

Purpose of Review

Compare outcomes of medical therapy as compared to minimally invasive surgical therapy (MIST) for treatment of bladder outlet obstruction

Recent Findings

Treatment for lower urinary tract symptoms due to benign prostatic hyperplasia (LUTS/BPH) remains largely driven by patient symptomatology with medical therapy or watchful waiting as the first-line management strategies. However, most patients are not adherent to prescribed medical therapies and are hesitant to accept the risks associated with more invasive therapies. Minimally invasive surgical therapies are treatments providing short-term symptom relief superior to medical therapies without the sequela of more invasive procedures.

Summary

Though there are few direct comparisons, MIST seems to relieve LUTS/BPH symptoms at least as well as medical therapy without the need for daily adherence.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22(Suppl 1):1–6.

    PubMed  Google Scholar 

  2. McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, et al. Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol. 2011;185(5):1793–803.

    Article  PubMed  Google Scholar 

  3. Martin S, Lange K, Haren MT, Taylor AW, Wittert G, Members of the Florey Adelaide Male Ageing Study. Risk factors for progression or improvement of lower urinary tract symptoms in a prospective cohort of men. J Urol. 2014;191(1):130–7.

    Article  PubMed  Google Scholar 

  4. Van Asseldonk B, Barkin J, Elterman DS. Medical therapy for benign prostatic hyperplasia: a review. Can J Urol. 2015;22(Suppl 1):7–17.

    PubMed  Google Scholar 

  5. Fenter TC, Naslund MJ, Shah MB, Eaddy MT, Black L. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006;12(4 Suppl):S90–8.

    PubMed  Google Scholar 

  6. Cindolo L, Pirozzi L, Fanizza C, Romero M, Tubaro A, Autorino R, et al. Drug adherence and clinical outcomes for patients under pharmacological therapy for lower urinary tract symptoms related to benign prostatic hyperplasia: population-based cohort study. Eur Urol. 2015;68(3):418–25.

    Article  PubMed  Google Scholar 

  7. Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med. 1995;332(2):75–9.

    Article  CAS  PubMed  Google Scholar 

  8. Liatsikos E, Kyriazis I, Kallidonis P, Stolzenburg JU. Bloodless management of benign prostatic hyperplasia: medical and minimally invasive treatment options. Aging Male. 2011;14(3):141–9.

    Article  PubMed  Google Scholar 

  9. Djavan B, Marberger M. A meta-analysis on the efficacy and tolerability of alpha1-adrenoceptor antagonists in patients with lower urinary tract symptoms suggestive of benign prostatic obstruction. Eur Urol. 1999;36(1):1–13.

    Article  CAS  PubMed  Google Scholar 

  10. Blankstein U, Van Asseldonk B, Elterman DS. BPH update: medical versus interventional management. Can J Urol. 2016;23(Suppl 1):10–5.

    PubMed  Google Scholar 

  11. Andriole G, et al. Dihydrotestosterone and the prostate: the scientific rationale for 5alpha-reductase inhibitors in the treatment of benign prostatic hyperplasia. J Urol. 2004;172(4 Pt 1):1399–403.

    Article  CAS  PubMed  Google Scholar 

  12. Rittmaster RS, Norman RW, Thomas LN, Rowden G. Evidence for atrophy and apoptosis in the prostates of men given finasteride. J Clin Endocrinol Metab. 1996;81(2):814–9.

    CAS  PubMed  Google Scholar 

  13. McConnell JD, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349(25):2387–98.

    Article  CAS  PubMed  Google Scholar 

  14. Kaplan SA, Roehrborn CG, Rovner ES, Carlsson M, Bavendam T, Guan Z. Tolterodine and tamsulosin for treatment of men with lower urinary tract symptoms and overactive bladder: a randomized controlled trial. JAMA. 2006;296(19):2319–28.

    Article  CAS  PubMed  Google Scholar 

  15. Otsuki H, Kosaka T, Nakamura K, Mishima J, Kuwahara Y, Tsukamoto T. Beta3-adrenoceptor agonist mirabegron is effective for overactive bladder that is unresponsive to antimuscarinic treatment or is related to benign prostatic hyperplasia in men. Int Urol Nephrol. 2013;45(1):53–60.

    Article  CAS  PubMed  Google Scholar 

  16. Rosenberg MT, et al. A practical primary care approach to overactive bladder. Can J Urol. 2014;21(Suppl 2):2–11.

    PubMed  Google Scholar 

  17. Roehrborn CG, Barkin J, Tubaro A, Emberton M, Wilson TH, Brotherton BJ, et al. Influence of baseline variables on changes in International Prostate Symptom Score after combined therapy with dutasteride plus tamsulosin or either monotherapy in patients with benign prostatic hyperplasia and lower urinary tract symptoms: 4-year results of the CombAT study. BJU Int. 2014;113(4):623–35.

    Article  CAS  PubMed  Google Scholar 

  18. Pan F, Chernew ME, Fendrick AM. Impact of fixed-dose combination drugs on adherence to prescription medications. J Gen Intern Med. 2008;23(5):611–4.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Roehrborn CG, Oyarzabal Perez I, Roos EP, Calomfirescu N, Brotherton B, Wang F, et al. Efficacy and safety of a fixed-dose combination of dutasteride and tamsulosin treatment (Duodart((R)) ) compared with watchful waiting with initiation of tamsulosin therapy if symptoms do not improve, both provided with lifestyle advice, in the management of treatment-naive men with moderately symptomatic benign prostatic hyperplasia: 2-year CONDUCT study results. BJU Int. 2015;116(3):450–9.

    Article  CAS  PubMed  Google Scholar 

  20. Montorsi F, Aversa A, Moncada I, Perimenis P, Porst H, Barker C, et al. A randomized, double-blind, placebo-controlled, parallel study to assess the efficacy and safety of once-a-day tadalafil in men with erectile dysfunction who are naive to PDE5 inhibitors. J Sex Med. 2011;8(9):2617–24.

    Article  CAS  PubMed  Google Scholar 

  21. Oelke M, Giuliano F, Mirone V, Xu L, Cox D, Viktrup L. Monotherapy with tadalafil or tamsulosin similarly improved lower urinary tract symptoms suggestive of benign prostatic hyperplasia in an international, randomised, parallel, placebo-controlled clinical trial. Eur Urol. 2012;61(5):917–25.

    Article  CAS  PubMed  Google Scholar 

  22. Glina S, Roehrborn CG, Esen A, Plekhanov A, Sorsaburu S, Henneges C, et al. Sexual function in men with lower urinary tract symptoms and prostatic enlargement secondary to benign prostatic hyperplasia: results of a 6-month, randomized, double-blind, placebo-controlled study of tadalafil coadministered with finasteride. J Sex Med. 2015;12(1):129–38.

    Article  CAS  PubMed  Google Scholar 

  23. Gacci M, Corona G, Salvi M, Vignozzi L, McVary KT, Kaplan SA, et al. A systematic review and meta-analysis on the use of phosphodiesterase 5 inhibitors alone or in combination with alpha-blockers for lower urinary tract symptoms due to benign prostatic hyperplasia. Eur Urol. 2012;61(5):994–1003.

    Article  CAS  PubMed  Google Scholar 

  24. Oelke M, Bachmann A, Descazeaud A, Emberton M, Gravas S, Michel MC, et al. EAU guidelines on the treatment and follow-up of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction. Eur Urol. 2013;64(1):118–40.

    Article  PubMed  Google Scholar 

  25. Kaye JD, Smith AD, Badlani GH, Lee BR, Seideman CA, Ost MC. High-energy transurethral thermotherapy with CoreTherm approaches transurethral prostate resection in outcome efficacy: a meta-analysis. J Endourol. 2008;22(4):713–8.

    Article  PubMed  Google Scholar 

  26. Wagrell L, Schelin S, Nordling J, Richthoff J, Magnusson B, Schain M, et al. Three-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology. 2004;64(4):698–702.

    Article  PubMed  Google Scholar 

  27. Mattiasson, A., Wagrell L., Schelin S., Nordling J., Richthoff J., Magnusson B., Schain M., Larson T., Boyle E., Duelund-Jacobsen J., Kroyer K., Ageheim H., Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomized multicenter study. Urology, 2007. 69(1): p. 91–96; discussion 96–7.

    Article  PubMed  Google Scholar 

  28. Djavan B, et al. Prospective randomized comparison of high energy transurethral microwave thermotherapy versus alpha-blocker treatment of patients with benign prostatic hyperplasia. J Urol. 1999;161(1):139–43.

    Article  CAS  PubMed  Google Scholar 

  29. Rukstalis DB. Prostatic urethral lift: a novel approach for managing symptomatic BPH in the aging man. Can J Urol. 2015;22(Suppl 1):67–74.

    PubMed  Google Scholar 

  30. Roehrborn CG, Rukstalis DB, Barkin J, Gange SN, Shore ND, Giddens JL, et al. Three year results of the prostatic urethral L.I.F.T. study. Can J Urol. 2015;22(3):7772–82.

    PubMed  Google Scholar 

  31. • Roehrborn, C.G., et al., Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study. Can J Urol, 2017. 24(3): p. 8802–8813. The results of a prospective multicenter randomized study comparing Urolift to a sham operation. The authors clearly show that not only is there an immediate and significant symptomatic improvement but that this improvement continues at 5 years.

  32. McNicholas TA. Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system. Med Devices (Auckl). 2016;9:115–23.

    PubMed Central  Google Scholar 

  33. McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Minimally invasive prostate convective water vapor energy ablation: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. J Urol. 2016;195(5):1529–38.

    Article  PubMed  Google Scholar 

  34. McVary KT, Gange SN, Gittelman MC, Goldberg KA, Patel K, Shore ND, et al. Erectile and ejaculatory function preserved with convective water vapor energy treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: randomized controlled study. J Sex Med. 2016;13(6):924–33.

    Article  PubMed  Google Scholar 

  35. Roberts WW. New technologies in benign prostatic hyperplasia management. Curr Opin Urol. 2016;26(3):254–8.

    Article  PubMed  Google Scholar 

  36. Mynderse LA, Hanson D, Robb RA, Pacik D, Vit V, Varga G, et al. Rezum system water vapor treatment for lower urinary tract symptoms/benign prostatic hyperplasia: validation of convective thermal energy transfer and characterization with magnetic resonance imaging and 3-dimensional renderings. Urology. 2015;86(1):122–7.

    Article  PubMed  Google Scholar 

  37. McVary KT, Roehrborn CG. Three-year outcomes of the prospective, randomized controlled Rezum system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Urology. 2018;111:1–9.

    Article  PubMed  Google Scholar 

  38. Elhilali MM, Pommerville P, Yocum RC, Merchant R, Roehrborn CG, Denmeade SR. Prospective, randomized, double-blind, vehicle controlled, multicenter phase IIb clinical trial of the pore forming protein PRX302 for targeted treatment of symptomatic benign prostatic hyperplasia. J Urol. 2013;189(4):1421–6.

    Article  CAS  PubMed  Google Scholar 

  39. Ebbing J, Bachmann A. Anesthesia-free procedures for benign prostate obstruction: worth it? Curr Opin Urol. 2015;25(1):32–9.

    Article  PubMed  Google Scholar 

  40. Nickel JC. The economics of medical therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia. Curr Urol Rep. 2006;7(4):282–7.

    Article  PubMed  Google Scholar 

  41. McDonald H, Hux M, Brisson M, Bernard L, Nickel JC. An economic evaluation of doxazosin, finasteride and combination therapy in the treatment of benign prostatic hyperplasia. Can J Urol. 2004;11(4):2327–40.

    PubMed  Google Scholar 

  42. Stovsky MD, Rhee K, Hartke D. Medical therapy versus surgery and minimally invasive surgical therapies for lower urinary tract symptoms and benign prostatic hyperplasia: what makes better economic sense? Curr Urol Rep. 2007;8(4):289–97.

    Article  PubMed  Google Scholar 

  43. Ohsfeldt RL, Kreder KJ, Klein RW, Chrischilles EA. Cost-effectiveness of tamsulosin, doxazosin, and terazosin in the treatment of benign prostatic hyperplasia. J Manag Care Pharm. 2004;10(5):412–22.

    PubMed  Google Scholar 

  44. • Ulchaker, J.C. and M.S. Martinson, Cost-effectiveness analysis of six therapies for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Clinicoecon Outcomes Res, 2018. 10: p. 29–43. Cost-effective analysis showing the upfront cost of a procedure is greater than medical therapy for 1 year, but that cost advantage is lost after a few years when considering the aggregate cost of medical therapies.

    Article  PubMed  Google Scholar 

  45. Lerner LB, Thurmond P, Harsch MR, Martinson MS. Office-based HE-TUMT costs less than medication over four years in treating benign prostatic hyperplasia. Surg Technol Int. 2015;26:182–9.

    PubMed  Google Scholar 

  46. • Gupta N, Rogers T, Holland B, Helo S, Dynda D, McVary KT. 3-Year treatment outcomes of water vapor thermal therapy (Rezum system) compared to doxazosin, finasteride and combination drug therapy for men with benign prostatic hyperplasia: cohort data from the Medical Therapy of Prostatic Symptoms (MTOPS) trial. J Urol. 2018. Cross-study analysis of 3-year outcomes comparing patients who underwent Rezum to patient-matched data from the MTOPS trial. The initial symptomatic improvement compared to medical therapy was maintained at 3-year follow-up;200:405–13.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Urology, Robert Wood Johnson Medical School, 125 Patterson St, MEB 584A, New Brunswick, NJ, 08901, USA

    Joshua Sterling, Nicholas Farber & Nikhil K. Gupta

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  1. Joshua Sterling
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  2. Nicholas Farber
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Correspondence to Nikhil K. Gupta.

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Joshua Sterling and Nicholas Farber each declare no potential conflicts of interest.

Nikhil K. Gupta reports a grant from Boston Scientific.

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Sterling, J., Farber, N. & Gupta, N.K. Comparing Outcomes of Medical Management and Minimally Invasive Surgical Techniques for Lower Urinary Tract Symptoms due to BPH. Curr Urol Rep 20, 29 (2019). https://doi.org/10.1007/s11934-019-0896-2

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