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

  • Joshua Sterling
  • Nicholas Farber
  • Nikhil K. GuptaEmail author
Benign Prostatic Hyperplasia (K McVary, Section Editor)
  • 12 Downloads
Part of the following topical collections:
  1. Topical Collection on Benign Prostatic Hyperplasia

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.

Keywords

LUTS BPH MIST Bladder outlet obstruction 

Notes

Compliance with Ethical Standards

Conflict of Interest

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

Nikhil K. Gupta reports a grant from Boston Scientific.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

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

  1. 1.
    Vuichoud C, Loughlin KR. Benign prostatic hyperplasia: epidemiology, economics and evaluation. Can J Urol. 2015;22(Suppl 1):1–6.PubMedGoogle Scholar
  2. 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.PubMedGoogle Scholar
  3. 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.PubMedGoogle Scholar
  4. 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.PubMedGoogle Scholar
  5. 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.PubMedGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. 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.PubMedGoogle Scholar
  8. 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.PubMedGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. 10.
    Blankstein U, Van Asseldonk B, Elterman DS. BPH update: medical versus interventional management. Can J Urol. 2016;23(Suppl 1):10–5.PubMedGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. 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.PubMedGoogle Scholar
  14. 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.PubMedGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 16.
    Rosenberg MT, et al. A practical primary care approach to overactive bladder. Can J Urol. 2014;21(Suppl 2):2–11.PubMedGoogle Scholar
  17. 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.PubMedGoogle Scholar
  18. 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.PubMedPubMedCentralGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 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.PubMedGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 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.PubMedGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. 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.PubMedGoogle Scholar
  25. 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.PubMedGoogle Scholar
  26. 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.PubMedGoogle Scholar
  27. 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.PubMedGoogle Scholar
  28. 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.PubMedGoogle Scholar
  29. 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.PubMedGoogle Scholar
  30. 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.PubMedGoogle Scholar
  31. 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. Google Scholar
  32. 32.
    McNicholas TA. Benign prostatic hyperplasia and new treatment options - a critical appraisal of the UroLift system. Med Devices (Auckl). 2016;9:115–23.PubMedCentralGoogle Scholar
  33. 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.PubMedGoogle Scholar
  34. 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.PubMedGoogle Scholar
  35. 35.
    Roberts WW. New technologies in benign prostatic hyperplasia management. Curr Opin Urol. 2016;26(3):254–8.PubMedGoogle Scholar
  36. 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.PubMedGoogle Scholar
  37. 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.PubMedGoogle Scholar
  38. 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.PubMedGoogle Scholar
  39. 39.
    Ebbing J, Bachmann A. Anesthesia-free procedures for benign prostate obstruction: worth it? Curr Opin Urol. 2015;25(1):32–9.PubMedGoogle Scholar
  40. 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.PubMedGoogle Scholar
  41. 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.PubMedGoogle Scholar
  42. 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.PubMedGoogle Scholar
  43. 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.PubMedGoogle Scholar
  44. 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. PubMedGoogle Scholar
  45. 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.PubMedGoogle Scholar
  46. 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.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Joshua Sterling
    • 1
  • Nicholas Farber
    • 1
  • Nikhil K. Gupta
    • 1
    Email author
  1. 1.Division of UrologyRobert Wood Johnson Medical SchoolNew BrunswickUSA

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