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Bhatia A, Porto JG, Titus RS, Ila V, Shah K, Malpani A, Lopategui DM, Marcovich R, Herrmann TRW, Shah HN. A systematic review and network meta-analysis comparing Rezūm with transurethral needle ablation and microwave thermotherapy for the management of enlarged prostate. BJUI COMPASS 2024; 5:621-635. [PMID: 39022654 PMCID: PMC11250421 DOI: 10.1002/bco2.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 07/20/2024] Open
Abstract
Objectives We aim to compare efficacy and safety of water vapour therapy (Rezūm), transurethral needle ablation (TUNA) and transurethral microwave therapy (TUMT) for treating men with moderate to severe benign prostatic hyperplasia (BPH) symptoms. Materials PubMed/MEDLINE, EMBASE and Cochrane Library were searched from inception to 30 July 2023, followed by reference searching and dual-independent study selection. We analysed only randomized clinical trials. RoB-2, NIH-quality assessment tool and GRADE guidelines were used for quality-of-evidence (QoE) assessment. Relevant prospective studies without a critical risk-of-bias were included. Results At 12 months, Rezūm showed similar efficacy to TUNA and TUMT for improvement in International Prostate Symptoms Score - Rezūm versus TUMT: 1.33 points (95% CI: -1.66 to 4.35) favouring TUMT (QoE: Moderate) and Rezūm versus TUNA: 0.07 points (95% CI: -3.64 to 3.88) favouring TUNA (QoE: Low). Rezum had similar outcomes to TUNA and TUMT for Maximum Peak-Flow Rate (Qmax): Rezūm versus TUMT: 1.05 mL/s (95% CI: -4.88 to 2.82) favouring Rezūm (QoE: Low) and Rezūm versus TUNA: 0.37 mL/s (95% CI: -4.61 to 4.21) favouring TUNA (QoE: Low). Furthermore, post-void residual volume (PVR) comparisons demonstrated that Rezūm was similar, or inferior to other techniques at 12 months - Rezūm versus TUMT: 11.20 mL (95% CI: -32.40 to 10.30) favouring TUMT (QoE: Low) and Rezūm versus TUNA: 24.10 mL (95% CI: 2.81 to 45.10) favouring TUNA (QoE: Low). Rezūm also had a similar surgical retreatment rate with TUMT and TUNA up to 3-years - TUMT versus Rezūm RR: 1.21 (95% CI: 0.20 to 15.90) (QoE: Low) and TUNA versus Rezūm showed RR: 1.81 (95% CI: 0.2 to 24.60) (QoE: Low). In the first 12 months after treatment, Rezūm had a higher rate of serious adverse events (Clavien-Dindo ≥ Grade 3) than TUMT and TUNA. TUMT versus Rezūm with RR = 0.53 (95% CI: 0.13 to 3.14) (QoE: Low) and TUNA versus Rezūm with RR = 0.38 (95% CI: 0.04 to 3.49) (QoE: Low). Conclusions Moderate to weak evidence suggests that Rezūm is not superior to TUNA and TUMT in all domains studied.
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Affiliation(s)
- Ansh Bhatia
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
- Seth GS Medical College and KEM HospitalMumbaiIndia
| | - Joao G. Porto
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Vishal Ila
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Khushi Shah
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Ankur Malpani
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Diana M. Lopategui
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | - Robert Marcovich
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Hemendra N. Shah
- Desai Sethi Urology Institute, Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
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Netsch C, Gross AJ, Herrmann TR, Herrmann J, Becker B. [Minimally-Invasive Surgical Techniques (MIST): Shedding Light on the Mist]. Aktuelle Urol 2024; 55:219-227. [PMID: 38547919 DOI: 10.1055/a-2269-1280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
As life expectancy increases and there is growing demand for BPH treatments, innovative technologies have been developed, allowing for swift recovery, symptom relief, low complication rates, and the possibility of performing procedures on an outpatient basis, often under local anaesthesia. This review aims to describe the outcomes of newly developed minimally-invasive surgical therapies (MIST) for BPH treatment in terms of functional voiding parameters and sexual function. These therapies are categorized into primarily ablative (Aquablation [Aquabeam]), non-ablative (Prostatic Urethral Lift (PUL, Urolift), temporary implantable devices [iTind]), and secondarily ablative procedures (convective water vapor ablation, Rezum, Prostate Artery Embolization [PAE]). All MIST technologies have advanced the medical care of patients with BPH while preserving ejaculation. However, there is a shortage of long-term data specifically addressing re-intervention rates and the preservation of functional voiding parameters. Although there is promising data from regulatory trials and randomized studies, all MIST therapies are potentially associated with severe complications. Patients considering such methods must be thoroughly informed about their inferiority compared with established transurethral procedures like TUR-P and enucleation.
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Affiliation(s)
| | - Andreas J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | | | - Jonas Herrmann
- Urologie und Urochirurgie, Universitätsklinikum Mannheim, Mannheim, Germany
| | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
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Minore A, Morselli S, Franzoso F, Maruzzi D, Varvello F, Toso S, Ferrari G, Siena G, Conti E, Papalia R, Uricchio F, Balsamo R, Scarpa RM, Cindolo L. Is water vapor thermal therapy safe and feasible in elderly and frail men? The Italian experience. World J Urol 2024; 42:60. [PMID: 38280069 DOI: 10.1007/s00345-023-04762-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/12/2023] [Indexed: 01/29/2024] Open
Abstract
PURPOSE In recent years, water vapor thermal therapy (WVTT) has spread as minimally invasive technique in lower urinary tract symptoms due to benign prostatic hyperplasia treatment. Even if its safety and feasibility have been largely proved in young men, nobody has proved the same feasibility and safety in the elderly (men older than 75 years old). Our aim is to compare WVTT safety outcomes in men older than 75 with younger men. METHODS We prospectively collected data on men who underwent water vapor thermal therapy from 2019. We compared data on operative time, number of injections, intra-operative and post-operative complications, reinterventions rate. RESULTS We enrolled 426 patients; among these, 60 were older than 75 years old, 366 were younger. Our cohorts of patients had similar results in terms of intra-operative and post-operative complications. Operative time accounts about 11 min for both groups (p = 0.535), total number of injections was seven for young men and eight for elderly (p = 0.314). We found no intra-operative complications in elderly men group and only one in the younger group (p = 0.678), while five younger men underwent clot retention, and two elderly men experienced this complication (p = 0.239). Only one transfusion occurred in the elderly group. No differences between groups occurred in terms of length of stay, post-operative urinary retention and reintervention rate, while catheterization time was longer in the elderly men. CONCLUSION WVTT is a safe procedure in elderly patients with comparable intra-operative and post-operative complication rate in comparison with younger patients.
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Affiliation(s)
- Antonio Minore
- Department of Urology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Simone Morselli
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | | | - Daniele Maruzzi
- Department of Urology, S. Maria Degli Angeli Hospital, Pordenone, Italy
| | - Francesco Varvello
- Department of Urology, Michele e Pietro Ferrero Hospital, Alba-Bra, Italy
| | - Stefano Toso
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | - Giovanni Ferrari
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, San Luca Nuovo, Florence, Italy
| | - Enrico Conti
- Department of Urology, Levante Ligure Hospital, La Spezia, Italy
| | - Rocco Papalia
- Department of Urology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Francesco Uricchio
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | - Raffaele Balsamo
- Department of Urology, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy
| | | | - Luca Cindolo
- Department of Urology, "Hesperia Hospital", and CURE Group, Modena, Italy.
- Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy.
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Salem J, Becher KF, Bschleipfer T, Dreikorn K, Höfner K, Madersbacher S, Magistro G, Muschter R, Oelke M, Reich O, Rieken M, Schönburg S, Abt D. [Minimally invasive treatment of benign prostatic hyperplasia : The German S2e guideline 2023-part 4]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:58-66. [PMID: 38193989 DOI: 10.1007/s00120-023-02249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Lower urinary tract symptoms suggestive for benign prostatic obstruction (LUTS/BPO) are one of the most frequent diseases in men and can have a significant impact on quality of life. Instrumental therapies are common, and many patients seek minimally invasive treatment options. OBJECTIVE Presentation and evidence-based evaluation of the minimally invasive therapy for benign prostatic syndrome. MATERIALS AND METHODS Summary and overview of chapters 11-13 on minimally invasive therapies for LUTS/BPO of the current long version of the German S2e guideline. RESULTS In case of absolute indication for surgery or after unsatisfactory or undesired medical therapy, minimally invasive treatments such as UroLift® (Neotract Inc., Pleasanton, CA, USA), Rezῡm™ (Boston Scientific, Malborough, MA, USA), iTIND™ (Olympus America Inc., Westborough, MA, USA), and prostatic artery embolization (PAE) can be considered. These indirect/delayed ablative therapies offer lower morbidity and the possibility of performing them under local anesthesia, but they are inferior to direct ablative/resective techniques in terms of effectiveness and sustainability. CONCLUSIONS The updated German S2e guideline summarizes evidence-based recommendations for new minimally invasive therapies for LUTS/BPO, which present alternative treatment options for selected patients.
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Affiliation(s)
- Johannes Salem
- CUROS urologisches Zentrum, Klinik LINKS VOM RHEIN, Schillingsrotterstr. 39-41, 50996, Köln, Deutschland.
- Klinik für Urologie und Kinderurologie, Universitätsklinikum Brandenburg a.d. Havel, MHB Brandenburg Theodor Fontane, Brandenburg a.d. Havel, Deutschland.
| | - Klaus F Becher
- Klinik für Rehabilitation, Klinik Wartenberg Professor Dr. Selmair GmbH & Co. KG, Wartenberg, Deutschland
| | - Thomas Bschleipfer
- Klinik für Urologie und Kinderurologie, Regiomed Klinikum, Coburg, Deutschland
| | | | - Klaus Höfner
- Klinik für Urologie, Evangelisches Krankenhaus, Oberhausen, Deutschland
| | | | - Giuseppe Magistro
- Klinik für Urologie, Asklepios Westklinikum GmbH, Hamburg, Deutschland
| | - Rolf Muschter
- Urologische Abteilung, ALTA Klinik, Bielefeld, Deutschland
| | - Matthias Oelke
- Klinik für Urologie, St. Antonius-Hospital GmbH, Gronau, Deutschland
| | | | | | - Sandra Schönburg
- Universitätsklinik und Poliklinik für Urologie und Nierentransplantation, Martin-Luther-Universität, Halle-Wittenberg, Deutschland
| | - Dominik Abt
- Klinik für Urologie, Spitalzentrum, Biel, Schweiz
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Schwartzmann I, García Barreras S, D'Anna M, Parejo V, Torneo Ruiz I, Tagalos Muñoz AC, Bravo-Balado A, Diana P, Peri L, Domínguez Esteban M, Fernández Guzmán E. Water vapor thermal therapy: Technical variations among spanish hospitals and efficacy at 2-year follow-up. Actas Urol Esp 2023; 47:668-674. [PMID: 37423384 DOI: 10.1016/j.acuroe.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/03/2023] [Indexed: 07/11/2023]
Abstract
AIM The aim of this work is to evaluate the initial experience with water vapor thermal therapy (WVTT) for benign prostatic hyperplasia (BPH) in Spanish university hospitals, as well as to describe the differences in technique and follow-up between centers. MATERIALS AND METHODS This retrospective observational multicenter study collected baseline characteristics, surgical, postoperative and follow-up data at 1, 3, 6, 12 and 24 months, including validated questionnaires, flowmetric variations, complications, and the need for pharmacological or surgical treatment following the procedure. Possible triggers for postoperative acute urinary retention (AUR) were also analyzed. RESULTS A total of 105 patients were included. No differences were observed between the groups with and without AUR with respect to catheterization time (5 and 4.3 days respectively, P=.178), or prostate volume (47.9g and 41.4g respectively, P=.147). The mean improvement at 3, 6, 12 and 24 months in terms of peak flow was 5.3, 5.2, 4.2 and 3.8ml/s, respectively. As for ejaculation, an improvement was observed after 3 months of follow-up and was maintained over time. CONCLUSIONS Minimally invasive treatment for BPH with WVTT shows good functional outcomes at 24 months follow-up, without significant impairment of sexual function and a low incidence of complications. There are minor inter-hospital variations, mainly in the immediate postoperative period.
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Affiliation(s)
- I Schwartzmann
- Servicio de Urología de la Fundació Puigvert, Barcelona, Spain.
| | | | - M D'Anna
- Servicio de Urología, Hospital Clínic, Barcelona, Spain
| | - V Parejo
- Servicio de Urología, Hospital de Girona Dr. Josep Trueta, Gerona, Spain
| | - I Torneo Ruiz
- Servicio de Urología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - A Bravo-Balado
- Servicio de Urología de la Fundació Puigvert, Barcelona, Spain
| | - P Diana
- Servicio de Urología de la Fundació Puigvert, Barcelona, Spain
| | - L Peri
- Servicio de Urología, Hospital Clínic, Barcelona, Spain
| | - M Domínguez Esteban
- Servicio de Urología, Hospital Universitario Marqués de Valdecillas, Santander, Spain
| | - E Fernández Guzmán
- Servicio de Urología, Hospital Universitario Marqués de Valdecillas, Santander, Spain
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Khooblall P, Bole R, Leelani N, Lundy S, Bajic P. A scoping review of ejaculatory dysfunction due to surgical treatments for benign prostatic hyperplasia: limitations of available tools for assessment and reporting. Sex Med Rev 2023; 11:375-383. [PMID: 36892248 DOI: 10.1093/sxmrev/qead002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/21/2022] [Accepted: 12/23/2022] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Clinicians primarily focus on the presence or absence of anterograde ejaculation following surgery for benign prostatic hyperplasia (BPH). Failing to assess dysfunctional ejaculation and associated bother in a granular fashion can underestimate the prevalence and significance of ejaculatory dysfunction in this population. OBJECTIVES This scoping review provides critical appraisal of existing tools assessing ejaculatory function and associated bother, emphasizing the importance of adequate history-taking, preoperative counseling, and supplemental questions that should be used prior to and after treatment. METHODS A literature review was conducted using pertinent keywords from 1946 to June 2022. Eligibility criteria included men developing ejaculatory dysfunction following BPH surgery. Measured outcomes included the assessment of patient bother related to ejaculatory function, pre- and postoperative scores from the Male Sexual Health Questionnaire (MSHQ). and Danish Prostate Symptom sexual function domain (DAN-PSSsex). RESULTS Results of this study included only 10 documented patients' bother due to ejaculatory dysfunction following treatment. Pre- and postoperative MSHQ were used as the diagnostic tool in 43/49 studies, one study documented "preservation of anterograde ejaculation", and one used DAN-PSSsex. Q1-4 of the MSHQ were used in 33/43 studies, 3/43 used Q1, 3, 5-7, 1/43 used solely Q4, 1/43 used Q1-3 + Q6 and Q7, and 5/43 used the entire MSHQ. No studies used post-ejaculation urinalysis to diagnose retrograde ejaculation. Only four studies explicitly documented bother and found 25-35% of patients were bothered with a "lack of ejaculate" or "other ejaculation difficulties" during sexual activity after BPH surgery. CONCLUSIONS There are currently no studies stratifying patient bother by various components of ejaculation (force, volume, consistency, sensation of seminal expulsion, painful ejaculation, etc.) after BPH surgery. Opportunities for improvement exist in reporting ejaculatory dysfunction related to BPH treatment. A comprehensive sexual health history is needed. Further investigation into effects of BPH surgical treatments on specific characteristics of the patient's experience of ejaculation is required.
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Affiliation(s)
- Prajit Khooblall
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Raevti Bole
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Navid Leelani
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Scott Lundy
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Petar Bajic
- Center for Men's Health, Glickmassn Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, United States
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Jue JS, Eid JF. Safety and efficacy of Rezūm™ in erectile dysfunction patients with and without an inflatable penile prosthesis[[es]]Seguridad y eficacia del sistema Rezūm® en pacientes con disfunción eréctil con y sin prótesis de pene inflable. Actas Urol Esp 2023; 47:87-91. [PMID: 37078849 DOI: 10.1016/j.acuroe.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/06/2022] [Indexed: 04/21/2023]
Abstract
PURPOSE This study evaluates the safety and efficacy of Rezūm™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). MATERIALS AND METHODS This was a retrospective review of ED patients who underwent Rezūm™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmax), and uroflowmetry average flow rate (Qavg) before and after Rezūm™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmax or Qavg. RESULTS A total of 17 patients with ED who underwent Rezūm™ were identified, including 11 patients with an IPP. The median follow-up after Rezūm™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmax (10.9 mL/s vs 9.8 mL/s, p = 0.04) and Qavg (7.5 mL/s vs 6.0 mL/s, p = 0.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmax or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. CONCLUSION Rezūm™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP.
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Affiliation(s)
- Joshua S Jue
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, USA.
| | - Jean-Francois Eid
- Department of Urology, Lenox Hill Hospital, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New York, USA; Advanced Urological Care, PC, New York, USA
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Tuna MB, Doğanca T, Argun ÖB, Pirdal BZ, Tüfek İ, Obek C, Kural AR. Water Vapor Thermal Therapy (Rezum™) for Benign Prostate Hyperplasia: Initial Experience from Turkiye. JOURNAL OF UROLOGICAL SURGERY 2022. [DOI: 10.4274/jus.galenos.2022.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Jue J, Eid J. Seguridad y eficacia del sistema Rezūm® en pacientes con disfunción eréctil con y sin prótesis de pene inflable. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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10
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Manfredi C, García-Gómez B, Arcaniolo D, García-Rojo E, Crocerossa F, Autorino R, Gratzke C, De Sio M, Romero-Otero J. Impact of Surgery for Benign Prostatic Hyperplasia on Sexual Function: A Systematic Review and Meta-analysis of Erectile Function and Ejaculatory Function. Eur Urol Focus 2022; 8:1711-1732. [PMID: 35803852 DOI: 10.1016/j.euf.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/17/2022] [Indexed: 01/25/2023]
Abstract
CONTEXT Several sexual side effects, including erectile, ejaculatory, and orgasmic dysfunction, were reported with the majority of surgical procedures for benign prostatic obstruction (BPO). OBJECTIVE To systematically review current evidence regarding the impact of benign prostatic hyperplasia (BPH) surgery on sexual function. EVIDENCE ACQUISITION A comprehensive bibliographic search on the MEDLINE, Cochrane Library, Embase, Web of Science, and Google Scholar databases was conducted in July 2021. The population, intervention, comparator, and outcome (PICO) model was used to define study eligibility. Studies were Included if they assessed patients with BPO and related lower urinary tract symptoms (P) undergoing BPH surgery (I) with or without a comparison between surgical treatments (C) evaluating the impact on sexual function (O). Retrospective and prospective primary studies were included. A pooled analysis was conducted on studies including the postoperative assessment of International Index of Erectile Function (IIEF)-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother), or retrograde ejaculation (RE) rate (PROSPERO database ID: CRD42020177907). EVIDENCE SYNTHESIS A total of 151 studies investigating 20 531 patients were included. Forty-eight randomized controlled trials evaluating 5045 individuals were eligible for the meta-analysis. In most studies (122, 80.8%), only erectile and/or ejaculatory function was evaluated. A substantial number of articles (67, 44.4%) also used nonvalidated tools to evaluate erectile and/or ejaculatory function. The pooled analysis showed no statistically significant changes in IIEF-5 score compared with baseline for the transurethral resection of the prostate (TURP; weighted mean difference [WMD] 0.76 pts; 95% confidence interval [CI] -0.1, 1.62; p = 0.08), laser procedure (WMD 0.33 pts; 95% CI -0.1, 0.77; p = 0.13), and minimally invasive treatment (WMD -1.37 pts; 95% CI -3.19, 0.44; p = 0.14) groups. A statistically significantly higher rate of RE was found after TURP (risk ratio [RR] 13.31; 95% CI 8.37, 21.17; p < 0.00001), other electrosurgical procedures (RR 34.77; 95% CI 10.58, 127.82; p < 0.00001), and the entire laser group (RR 17.37; 95% CI 5.93, 50.81; p < 0.00001). No statistically significant increase in RE rate was described after most of the minimally invasive procedures (p > 0.05). The pooled analysis of MSHQ-EjD scores was possible only for prostatic urethral lift, showing no statistically significant difference between baseline and post-treatment MSHQ-EjD Function scores (WMD -0.80 pts; 95% CI -2.41, 0.81; p = 0.33), but postoperative MSHQ-EjD Bother scores were significantly higher (WMD 0.76 pts; 95% CI 0.22, 1.30; p = 0.006). CONCLUSIONS Erectile function appears to be unaffected by most surgical procedures for BPO. RE is a very common adverse event of BPH surgery, although emerging minimally invasive surgical procedures could be associated with a lower risk. PATIENT SUMMARY Benign prostatic hyperplasia surgery can have an impact on sexual function, mainly involving ejaculatory function.
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Affiliation(s)
- Celeste Manfredi
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Borja García-Gómez
- Department of Urology, Hospital Universitario 12 Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Davide Arcaniolo
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Esther García-Rojo
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain
| | - Fabio Crocerossa
- Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Riccardo Autorino
- Division of Urology, Virginia Commonwealth University, Richmond, VA, USA
| | - Christian Gratzke
- Department of Urology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Marco De Sio
- Urology Unit, Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Javier Romero-Otero
- Department of Urology, HM Hospitales (Montepríncipe, Puerta del Sur, Sanchinarro), Madrid, Spain; ROC Clinic, Madrid, Spain.
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11
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Michel MC, Madersbacher S. [Medical treatment of male lower urinary tract symptoms: what's new?]. Aktuelle Urol 2022; 53:240-245. [PMID: 35193150 DOI: 10.1055/a-1749-4556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Decades after the introduction of 5α-reductase inhibitors and α1-adrenoceptor antagonists, new data of practical relevance related to their desired and adverse effects continues to emerge. Some of these novel findings are to be taken seriously but are insufficiently established, for instance associations between drug use and depression or dementia. Multiple combination treatments have been tested. While combination treatment was often statistically superior to monotherapy, the difference was mostly in the range of 1 IPSS point, which raises doubts on the clinical relevance of the findings at the group level. The new evidence enables further personalisation of the treatment of male lower urinary tract dysfunction, but also makes individual risk-benefit considerations more complex.
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Affiliation(s)
- Martin C. Michel
- Pharmacology, Johannes Gutenberg University Hospital Mainz, Mainz, Germany
| | - Stephan Madersbacher
- Urologie, Kaiser Franz Josef Krankenhaus, Sigmund Freud Privatuniversität, Wien, Austria
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12
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Babar M, Loloi J, Tang K, Syed U, Ciatto M. Emerging outcomes of water vapor thermal therapy (Rezum) in a broad range of patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia: A systematic review. Low Urin Tract Symptoms 2022; 14:140-154. [PMID: 35233955 DOI: 10.1111/luts.12435] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
Water vapor thermal therapy (Rezum) is a novel, minimally invasive surgical technology used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). The objective of this systematic review is to evaluate the latest efficacy and safety profile of Rezum in patients with LUTS secondary to BPH. PubMed/MEDLINE and the Cochrane Library databases were systematically searched, in accordance with the PRISMA statement, for relevant articles in the English language till 1 August 2021. Randomized and nonrandomized studies that evaluated urinary outcomes and/or adverse events were deemed eligible. Nineteen studies (N = 1942), published in 25 articles, were included. International Prostate Symptom Score (IPSS), quality of life (QoL), and maximum urinary flow rate (Qmax) significantly improved as early as 1 month postoperatively and remained durable for up to 5 years. Significant median percent improvements in IPSS, QoL, and Qmax at 3 months were 51%, 51%, and 66%, respectively. Patients with obstructive median lobes, large prostates (>80 g), small prostates (<30 g), and urinary retention also experienced significant relief in LUTS, with 83% of urinary retention patients becoming catheter independent at a median of 14 days. Most adverse events were transient and nonserious and occurred in 0% to 76% of patients (median 29%), with de novo erectile dysfunction rates ranging between 0% and 3.1%. Surgical retreatment rate ranged between 4.4% and 7.5% at 5 years postoperatively. Rezum provides durable improvements in symptoms, irrespective of prostate volume and urinary retention status, and has low rates of sexual dysfunction.
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Affiliation(s)
- Mustufa Babar
- Albert Einstein College of Medicine, Bronx, New York, USA.,DSS Urology, Queens Village, New York, USA
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, New York, USA
| | - Kevin Tang
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Umar Syed
- DSS Urology, Queens Village, New York, USA
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13
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Gao B, Lu S, Bhojani N, Zorn KC, Chughtai B, Elterman D. Office-Based Procedures for BPH. Curr Urol Rep 2021; 22:63. [PMID: 34913101 DOI: 10.1007/s11934-021-01081-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE OF REVIEW Benign prostatic hyperplasia (BPH) is a common disease in men. A rapidly rising demand for safe and effective therapy for BPH has generated novel minimally invasive surgical treatments (MISTs). With multiple procedural options in the urology armamentarium for BPH therapy, we describe the current therapies and outcomes for office-based procedures for BPH including quality of life, voiding symptoms, and sexual function. RECENT FINDINGS There are three FDA-approved MISTs (Rezūm, Urolift, and iTind) and three emerging MISTs for BPH. Preliminary data suggest improvement in voiding symptoms and quality of life while minimizing unwanted sexual side effects. Long term data is required on the durability and safety of MISTs for BPH. MISTs mark a paradigm shift in BPH management. Sandwiched between conservative medical management and conventional transurethral surgery, these novel technologies promise to combine efficacy approaching that of TURP while sparing the negative side effects. We envision a future where BPH can be diagnosed and treated in an office-based setting with a standard cystoscope in one procedure.
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Affiliation(s)
- Bruce Gao
- Division of Urology, Department of Surgery, University of Toronto, Room 503G, 149 College Street, Toronto, ON, M5T 1P5, Canada
| | - Steven Lu
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Naeem Bhojani
- Department of Surgery, University of Montreal (CHUM), 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Kevin C Zorn
- Department of Surgery, University of Montreal (CHUM), 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
| | - Bilal Chughtai
- Department of Urology, Weill Cornell Medical College, 25 East 68th Street, Starr 9, New York, NY, 10065, USA
| | - Dean Elterman
- Division of Urology, Department of Surgery, University of Toronto, Room 503G, 149 College Street, Toronto, ON, M5T 1P5, Canada. .,UHN - Toronto Western Hospital, 399 Bathurst Street, MP-8-317, Toronto, ON, M5T2S8, Canada.
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14
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Kim J, Polchert M, Chacko B, Tannenbaum J, Raheem O. Do Minimally Invasive Benign Prostatic Hyperplasia Treatments Preserve Sexual Function? A Contemporary Review of the Literature. Curr Urol Rep 2021; 22:56. [PMID: 34727240 DOI: 10.1007/s11934-021-01071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to compare the sexual function outcomes related to minimally invasive surgical therapies (MISTs) (UroLift®, Rezum™, Aquablation®, prostate artery embolization, and iTind®) for the treatment of benign prostatic hyperplasia (BPH). RECENT FINDINGS Clinical trials and retrospective data evaluating MISTs for BPH have demonstrated improved or stable sexual function outcomes when compared to sham control or transurethral resection of the prostate. Outcomes were assessed at baseline and following treatments using patient-reported outcome measures. Rezum and Aquablation demonstrated preservation of overall ejaculatory function and erectile function at 36-month follow-up. Similar outcomes occurred with UroLift after a 60-month follow-up. Erectile function was preserved following prostate artery embolization and iTIND up to 12 months. MIST for the management of BPH has been demonstrated to be effective in improving urinary function and appears to minimize potential collateral damage on sexual function following treatment.
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Affiliation(s)
- Joseph Kim
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Michael Polchert
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Benjamin Chacko
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Jacob Tannenbaum
- Department of Urology, Tulane University School of Medicine, 1430 Tulane Ave, New Orleans, LA, 70112, USA
| | - Omer Raheem
- The University of Chicago Medical Center, Pritzker School of Medicine, Chicago, USA.
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15
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Contreras P, Bonanno N, Rios Pita H, Villasante N, Ameri CA, Blas L. Response to Yafi re: "Antegrade Ejaculation Preservation Technique with GreenLight XPS 180-W: Functional Ejaculatory Results". J Endourol 2021; 35:354. [PMID: 33617353 DOI: 10.1089/end.2021.29106.pco] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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16
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Effectiveness of convective water vapor energy therapy versus prostatic urethral lift for symptomatic benign prostatic hyperplasia: a systematic review and indirect comparison. World J Urol 2021; 39:3207-3215. [PMID: 33515055 DOI: 10.1007/s00345-021-03595-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To synthesize the evidence from randomized controlled trials of prostatic urethral lift (PUL) and convective water vapor thermal energy therapy (WAVE) for minimally invasive treatment of men with benign prostatic hyperplasia. METHODS A systematic search of databases was performed to identify trials comparing WAVE or PUL to either an active or sham surgery control in subjects with symptomatic benign prostatic obstruction. A controlled indirect treatment comparison based on the approach of Bucher was performed for outcomes including International Prostate Symptom Score and maximum urinary flow rate (Qmax). The durability of treatment response was assessed by life-table analysis of freedom from retreatment through 4 years. RESULTS Two multicenter sham-controlled trials (Rezum II Study, NCT01912339: LIFT Study, NCT01294150) were identified. The trials employed a common sham procedure and were similar with respect to their designs and subjects' baseline characteristics. Comparisons on the treatment effect in excess of sham response found non-significant differences between WAVE and PUL for symptom score [mean difference (MD): - 1.7 points; 95% confidence interval (CI): - 4.8, 1.4] but Qmax improvements favored WAVE [MD: 3.4 ml/sec; CI: 1.2, 5.6]. The proportion free of retreatment through 4 years was 89.1% for WAVE versus 75.4% for PUL [log-rank P = 0.004]. CONCLUSIONS PUL and WAVE provide similar subjective improvements but flow-rate improvement and durability of response seem greater for WAVE. The confirmation of these findings in a randomized trial is warranted.
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Abstract
Interventional therapies (IT) are increasingly popular treatment options for benign prostatic hyperplasia (BPH). IT aim to reduce morbidity and side effects related to invasive surgical procedures. To date, IT are considered experimental, though they are evolving rapidly and starting to challenge established surgical strategies. With gradually increasing evidence for the benefits of IT in BPH, several techniques are moving out of the realm of research and into everyday clinical practice. As such, IT provides encouraging mid-term functional outcomes with improved health-related quality of life (QoL), particularly in terms of better preservation of ejaculation. The distinct role IT could play as a bridge between exhausted drug-based treatment options and surgery is yet to be defined. Further studies are required before IT can be recommended as alternatives to invasive therapies. Systematic trials are needed to identify subgroups of patients who can benefit particularly from IT in comparison to other treatments, to identify features of the prostate particularly suited to a specific IT, and to analyze the durability of success for each technique.
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18
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Lebdai S, Chevrot A, Doizi S, Pradère B, Barry Delongchamps N, Baumert H, Benchikh A, Della Negra E, Fourmarier M, Gas J, Misraï V, Rouscoff Y, Theveniaud PE, Vincendeau S, Wilisch J, Descazeaud A, Robert G. [Surgical and interventional management of benign prostatic obstruction: Guidelines from the Committee for Male Voiding Disorders of the French Urology Association]. Prog Urol 2021; 31:249-265. [PMID: 33478868 DOI: 10.1016/j.purol.2020.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/24/2020] [Accepted: 12/04/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The aim of the Male Lower Urinary Tract Symptoms Committee (CTMH) of the French Urology Association was to propose an update of the guidelines for surgical and interventional management of benign prostatic obstruction (BPO). METHODS All available data published on PubMed® between 2018 and 2020 were systematically searched and reviewed. All papers assessing surgical and interventional management of adult patients with benign prostatic obstruction (BPO) were included for analysis. After studies critical analysis, conclusions with level of evidence and French guidelines were elaborated in order to answer the predefined clinical questions. RESULTS/GUIDELINES Offer a trans-uretral incision of the prostate to treat patients with moderate to severe lower urinary tract symptoms (LUTS) with a prostate volume<30cm3, without a middle lobe. TUIP increases the chances of preserving ejaculation. Propose mono- or bipolar trans-urethral resection of the prostate (TURP) to treat patients with moderate to severe LUTS with a prostate volume between 30 and 80cm3. Vaporization by Greenlight™ or by bipolar energy can be offered as an alternative to TURP. Offer a Greenlight™ laser vaporization to patients at risk of bleeding. Offer endoscopic prostate enucleation to surgically treat patients with moderate to severe LUTS as an alternative to TURP and open prostatectomy (OP). Minimally invasive prostatectomy is an alternative to OP in centers without access to adequate endoscopic procedures. Embolization of the prostatic arteries may be offered in the event of a contraindication or refusal of surgery for prostates with a volume>80cm3. Prostatic uretral lift is an alternative in patients interested in preserving their ejaculatory function and with a prostate volume<70cm3 without a middle lobe. Aquablation and Rezum™ are under evaluation and should be offered in research protocols. CONCLUSION Major changes in surgical management of BPO have occurred and aim at reducing morbidity and improving quality of life of patients.
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Affiliation(s)
- S Lebdai
- Service d'urologie, CHU d'Angers, Angers, France.
| | - A Chevrot
- Service d'urologie, CHU de Nîmes, Nîmes, France
| | - S Doizi
- Service d'urologie, hôpital européen Georges-Pompidou, Paris, France
| | - B Pradère
- Service d'urologie, CHU de Tours, Tours, France
| | | | - H Baumert
- Service d'urologie, hôpital Ambroise-Paré, Paris, France
| | - A Benchikh
- Service d'urologie, Clinique les Martinets, Versailles, France
| | - E Della Negra
- Service d'urologie, hôpital des Côtes d'Armor, Saint-Brieuc, France
| | - M Fourmarier
- Service d'urologie, hôpital Aix-en-Provence, Aix-en-Provence, France
| | - J Gas
- Service d'urologie, CHU de Toulouse, Toulouse, France
| | - V Misraï
- Service d'urologie, clinique Pasteur, Toulouse, France
| | - Y Rouscoff
- Service d'urologie, polyclinique Saint-Georges, Nice, France
| | - P E Theveniaud
- Service d'urologie, CHR de Metz Thionville, Metz, France
| | - S Vincendeau
- Service d'urologie, CHU de Rennes, Rennes, France
| | - J Wilisch
- Service d'urologie, hôpital privé Natecia, Lyon, France
| | - A Descazeaud
- Service d'urologie, CHU de Limoges, Limoges, France
| | - G Robert
- Service d'urologie, CHU de Bordeaux, Bordeaux, France
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19
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Doppalapudi SK, Gupta N. What Is New with Rezūm Water Vapor Thermal Therapy for LUTS/BPH? Curr Urol Rep 2021; 22:4. [PMID: 33403529 DOI: 10.1007/s11934-020-01018-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Rezum® is a novel convection-based thermal therapy for benign prostatic hyperplasia (BPH) induced lower urinary tract symptoms (LUTS). This review provides an overview of its safety, efficacy, cost, and potential role in the paradigm of BPH/LUTS therapies. RECENT FINDINGS Data regarding Rezum® stems primarily from one large randomized controlled trial of 197 patients with 4 years of follow-up. The efficacy and safety of Rezum® is further supported by 4 additional studies including 1 prospective pilot study, 1 crossover study, and 2 retrospective studies. Durable improvements in IPSS (47-60%), QoL (38-52%), Qmax (45-72%), and PVR (11-38%) were seen without causing deterioration of sexual function. Rezum® offers a cost-effective and safe approach to treating BPH/LUTS and should be considered as a possible first-line therapy for patients with moderate to severe symptoms.
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Affiliation(s)
- Sai K Doppalapudi
- Division of Urology, Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA.
| | - Nikhil Gupta
- Division of Urology, Robert Wood Johnson Medical School, 1 Robert Wood Johnson Place, New Brunswick, NJ, 08901, USA
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20
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Ng BHS, Chung E. A state-of-art review on the preservation of sexual function among various minimally invasive surgical treatments for benign prostatic hyperplasia: Impact on erectile and ejaculatory domains. Investig Clin Urol 2021; 62:148-158. [PMID: 33660441 PMCID: PMC7940857 DOI: 10.4111/icu.20200392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/11/2020] [Accepted: 11/08/2020] [Indexed: 12/27/2022] Open
Abstract
There is a strong association between benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and sexual dysfunction. While transurethral resection of the prostate (TURP) is considered the standard BPH treatment, it is however associated with a high rate of erectile and ejaculatory dysfunctions. Over the past decade, new and novel minimally invasive BPH therapies have been shown to improve various parameters of voiding domains while minimizing adverse sexual effects. These minimally invasive BPH therapies can be largely be divided into those with cavitating technology (Rezum, Histotripsy, Aquablation), intra-prostatic injections (Botulinum neurotoxin Type A, Fexapotide Triflutate, prostate specific antigen-activated protoxin PRX-302), and mechanical devices which include intraprostatic stents (Urospinal 2™, Memotherm™, Memokath™, and Allium triangular prostatic stent™) and intraprostatic devices (iTIND™, Urolift™), as well as prostatic artery embolization. Published literature on these technologies showed reasonable preservation of erectile function with limited data reported on ejaculatory domain. Further validation of the performance of these novel minimally invasive treatment options for LUTS due to BPH in well-designed and multi-centre studies are desired, to evaluate their role (or lack of such a role) in clinical practice and whether these BPH therapies can provide equivalent standard or better than TURP.
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Affiliation(s)
- Brian Hung Shin Ng
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia.,AndroUroloogy Centre, Brisbane, QLD, Australia.,Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
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21
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Mykoniatis I, Renterghem KV, Sokolakis I. How can we Preserve Sexual Function after Ablative Surgery for Benign Prostatic Hyperplasia? Curr Drug Targets 2020; 22:4-13. [PMID: 32981500 DOI: 10.2174/1389450121666200925143916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 05/28/2020] [Accepted: 07/08/2020] [Indexed: 12/22/2022]
Abstract
Our aim was to provide a narrative review regarding the prevalence, the associated pathophysiologic pathways and the potential management methods of sexual dysfunction related to ablative surgical techniques for Benign Prostatic Enlargement (BPE). Men suffering from BPE are at high risk of sexual dysfunction due to the disease itself, comorbidities, and pharmacological/surgical treatments. Transurethral resection of the prostate, as the gold standard treatment option for BPE, has historically been associated with relatively high rates of postoperative sexual dysfunction problems, mainly retrograde ejaculation but also erectile dysfunction. Ablative surgical techniques, including photoselective vaporization of the prostate (PVP), transurethral needle ablation (TUNA), Transurethral Microwave Therapy (TUMT), Convective Water Vapor Energy Ablation (Rezum®) and Aquablation®, have been proposed as treatment methods able to reduce treatment-related complications for BPE patients, including adverse effects on erectile and ejaculatory function, without compromising the efficacy rates for BPE. The neurovascular bundles can be damaged during TURP due to posterolateral capsular perforation. Ablative techniques and especially PVP theoretically seem to skip this hazard, as the distance created from the necrotic area to the capsule is generally larger compared to the distance induced after TURP. However, indirect thermal injury of erectile nerves, which could also be induced by the majority of available ablative techniques, could potentially lead to ED. Two special technical characteristics (physiological saline use for tissue ablation and real time penetration depth control) of Aquablation® could be proved beneficial with regard to the effect of the method on erectile function. In general, ablative techniques seem to have a minor impact on sexual function. However, low methodological quality characterizes most of the studies included in this review mainly due to the impossibility, in many cases, to perform blind randomization. Also, many studies did not have an erectile and ejaculatory function as primary outcomes limiting that way their statistical power to identify significant variations. Management of sexual dysfunction problems arising from ablative surgeries for BPE treatment could be divided into two levels. Firstly, intraoperatively the avoidance of manipulation of crucial structures regarding ejaculatory (bladder neck or ejaculatory ducts) and erectile function (neurovascular bundles) could possibly decrease the negative effect of these procedures on sexual function. Thus, in this direction, modifications of classic ablative techniques have been proposed resulting in encouraging outcomes regarding postoperative sexual function. Secondly, if EjD and/or ED are established, the already known treatment choices should be chosen in order for sexual function rehabilitation to be achieved. Thus, regarding ED: PDE5i daily or on-demand remains the gold standard first-line treatment choice followed by intracavernosal alprostadil injections in cases of failure, while penile prosthesis implantation must be kept as the final definitive solution when all the other methods have failed. Regarding ejaculation disorders (retrograde ejaculation or anejaculation): medical therapy with a-agonists (pseudoephedrine), sperm retrieval from the urine, bladder neck reconstruction, prostatic massage, electroejaculation, penile vibratory stimulation and surgical sperm retrieval are the available treatment options. Furthermore, high-quality studies are required to investigate the potential side effects of BPE surgery on sexual function and efficient treatment methods to manage them.
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Affiliation(s)
- Ioannis Mykoniatis
- Department of Urology, Jessa Hospital, Hasselt, Belgium; 2Faculty of medicine, Hasselt University, Hasselt, Belgium
| | - Koenraad Van Renterghem
- Department of Urology, Jessa Hospital, Hasselt, Belgium; 2Faculty of medicine, Hasselt University, Hasselt, Belgium
| | - Ioannis Sokolakis
- Department of Urology, Martha-Maria Hospital Nuremberg, Nuremberg, Germany
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22
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Wong A, Mahmalji W. The role of Rezūm ™ team ablation of the prostate in the treatment of patients with acute urinary retention secondary to benign prostatic hyperplasia. A single center, single surgeon case series and literature review. Aging Male 2020; 23:1620-1626. [PMID: 33818292 DOI: 10.1080/13685538.2021.1901273] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Acute urinary retention (AUR) is one of the most significant complication of benign prostatic hyperplasia (BPH). The gold standard surgical treatment for BPH, transurethral resection of the prostate (TURP), is not without significant side effects and a prolonged hospital stay. The aim of this study is to evaluate the role of Rezūm ™ steam ablation in the treatment of patients with AUR secondary to BPH. METHODS Patients who developed AUR and failed their trial without a catheter (TWOC) were recruited. They were counselled about the procedure and offered the treatment. Pre-operative, intraoperative and post operate data were collected. RESULTS All patients were followed up for a mean period of 7.2 months. 100% of patients passed their TWOC and stopped taking any BPH medications after. There was an average of 43.8% decrease in TRUS volume and a fall of 52.5% in PSA value after intervention. The mean operation time was 8.8 min and mean duration in hospital was 5.8 h. No deterioration in sexual function was reported. CONCLUSIONS Rezūm ™ steam ablation of the prostate is safe, fast and effective day case procedure in treating patients with AUR secondary to BPH. All patients were satisfied with the functional outcomes.
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Affiliation(s)
- Anton Wong
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
| | - Wasim Mahmalji
- Hereford County Hospital, Wye Valley NHS Trust, Hereford, UK
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23
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Lokeshwar SD, Valancy D, Lima TFN, Blachman-Braun R, Ramasamy R. A Systematic Review of Reported Ejaculatory Dysfunction in Clinical Trials Evaluating Minimally Invasive Treatment Modalities for BPH. Curr Urol Rep 2020; 21:54. [PMID: 33104947 DOI: 10.1007/s11934-020-01012-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To explore the sexual outcomes following the novel minimally invasive surgical procedures for benign prostatic hyperplasia- (BPH-) related lower urinary tract symptoms (LUTS), with an emphasis on ejaculatory dysfunction (EjD). RECENT FINDINGS A database search with a 10-year time restriction was carried out until February 20, 2020 using MEDLINE through the PubMed Platform evaluating minimally invasive treatment modalities for BPH and their effect on EjD. After the article selection, we retrieved data for men randomized in 19 different studies with results in 40 separate published articles investigating minimally invasive BPH surgery and reporting EjD rates. To date, water vapor thermal therapy or Rezūm, prostatic urethral lift (PUL) or UroLift®, prostate artery embolization (PAE), and Aquablation showed acceptable rates (< 2%) of retrograde ejaculation by 1 year and had very low adverse events related to the procedure. Both PUL and Rezūm demonstrated lower rates when compared with PAE and Aquablation. With comparable sexual side effect profiles postoperatively, clinicians may determine which therapeutic modality is optimal for patients based on efficacy and cost-benefit. Further randomized clinical trials are required to directly compare the effect of novel minimally invasive surgical procedures for BPH-related LUTS on ejaculation and sexual function.
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Affiliation(s)
- Soum D Lokeshwar
- Department of Urology, Yale Univeristy School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8058, USA
| | - David Valancy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Thiago Fernandes Negris Lima
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ruben Blachman-Braun
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, 1120 NW 14th Street, 15th Floor, Miami, FL, 33136, USA.
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24
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Alegorides C, Fourmarier M, Eghazarian C, Lebdai S, Chevrot A, Droupy S. Treatment of benign prostate hyperplasia using the Rezum® water vapor therapy system: Results at one year. Prog Urol 2020; 30:624-631. [DOI: 10.1016/j.purol.2020.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 11/16/2022]
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25
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Madersbacher S, Roehrborn CG, Oelke M. The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU Int 2020; 126:317-326. [DOI: 10.1111/bju.15154] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Stephan Madersbacher
- Department of Urology; Kaiser Franz Josef Hospital; Sigmund Freud Private University; Vienna Austria
| | | | - Matthias Oelke
- Department of Urology; St. Antonius Hospital; Gronau Germany
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26
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Dornbier R, Pahouja G, Branch J, McVary KT. The New American Urological Association Benign Prostatic Hyperplasia Clinical Guidelines: 2019 Update. Curr Urol Rep 2020; 21:32. [PMID: 32607874 DOI: 10.1007/s11934-020-00985-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW The goal of this paper was to analyze the efficacy of the current modalities available to surgically treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). RECENT FINDINGS There have been significant surgical advancements for the treatment of BPH, including an increasing development and utilization of minimally invasive surgical techniques (MISTs). These procedures have varying outcomes that are critical to understand. In addition, MISTs have important adverse effects, though have minimized effects on sexual function when compared to more invasive surgical techniques. It is important for all urologists to be familiar with the surgical techniques available to treat BPH and the updated American Urological Association (AUA) Guidelines. Further studies evaluating efficacy, safety, and sexual functioning will help guide care in the future and evolve practice.
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Affiliation(s)
- Ryan Dornbier
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA.
| | - Gaurav Pahouja
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Jeffrey Branch
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
| | - Kevin T McVary
- Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL, 60153, USA
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Schöb DS, Reichelt AC, Gross AJ, Abt D, Miernik A, Gratzke C. [Novel surgical techniques for treatment of benign prostatic hyperplasia]. Urologe A 2020; 59:347-358. [PMID: 32072200 DOI: 10.1007/s00120-020-01149-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In recent years new surgical techniques to treat benign prostatic hyperplasia have been introduced into urological practice and evaluated in clinical studies. Complications of standard procedures, e.g. transurethral resection of the prostate (TURP), can be avoided while maintaining equivalent clinical outcomes. The main goal is preservation of erectile and ejaculatory function. Furthermore, outpatient treatment associated with a rapid patient recovery would be desirable. This article presents the course of the interventions, the mechanisms of action and current clinical evidence for novel mechanical approaches of recanalization, water-based ablation as well as prostate artery embolization. Initial study results partially indicate that in the future practically all patients can be offered an individualized surgical technique, which provides optimal symptomatic and functional improvements with a minimized risk of complications.
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Affiliation(s)
- D S Schöb
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
| | - A C Reichelt
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - A J Gross
- Abteilung für Urologie, Asklepios Klinik Barmbek, Rübenkamp 220, 22291, Hamburg, Deutschland
| | - D Abt
- Klinik für Urologie, Kantonsspital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Schweiz
| | - A Miernik
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
| | - C Gratzke
- Medizinische Fakultät, Klinik für Urologie, Universitätsklinikum Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
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Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study. Urology 2019; 126:171-179. [PMID: 30677455 DOI: 10.1016/j.urology.2018.12.041] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/21/2018] [Accepted: 12/21/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To report 4-year outcomes of the randomized controlled trial of water vapor thermal therapy for treatment of moderate to severe lower urinary tract symptoms due to benign prostatic hyperplasia. MATERIALS AND METHODS Total 188 subjects; 135 men ≥50years old, International Prostate Symptom Score ≥ 13, maximum flow rate (Qmax) ≤15 mL/s and prostate volume 30 to 80 cc treated with Rezūm System thermal therapy were followed 4 years; subset of 53 men who requalified for crossover from control to active treatment were followed 3years. RESULTS Lower urinary tract symptoms were significantly improved within ≤3 months after thermal therapy and remained consistently durable (International Prostate Symptom Score 47%, quality of life 43%, Qmax 50%, Benign Prostatic Hyperplasia Impact Index 52%) throughout 4years (P <.0001); outcomes were similarly sustained in crossover subjects at 3years. Surgical retreatment rate was 4.4% over 4years. No disturbances in sexual function were reported. CONCLUSION The minimally invasive thermal therapy provides effective symptom relief and improved quality of life that remains durable for over 4years. It is applicable to all prostate zones with procedures performed under local anesthesia in an office setting.
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