Update in minimal invasive therapy in benign prostatic hyperplasia

P Van Hest, F D'Ancona
Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology 2009, 61 (3): 257-68
Last decade several new treatment modalities for minimal invasive therapy of benign prostatic hyperplasia have been developed, both ablative and non-ablative. In this review the authors describe the different techniques and clinical studies of bipolar transurethral resection of the prostate (TURP), transurethral resection in saline (TURis), the different laser therapies for the prostate, transurethral microwave thermotherapy (TUMT), high intensity focused ultrasound (HIFU), transurethral needle ablation (TUNA), hot water induced thermotherapy (WIT), prostatic stents, intraprostatic ethanol injections and botulinum toxin A injections. The different bipolar systems and photoselective vaporisation might replace the ''gold standard'', monopolar TURP, in the near future. The holmium laser enucleation of the prostate is also a real challenger of the ''gold standard'', but the technique is difficult to learn. The TUMT definitively found its place as alternative to TURP, especially because it can be performed in an outpatient setting without the need of anaesthesia. Therefore it is also suitable in patients at high risk. The long-term data on TUNA and HIFU is disappointing and therefore these treatment modalities did not stand the test of time. WIT seemed to be a promising therapy, but durability is questionable. Intraprostatic ethanol injections are safe and effective in small series, but larger series are needed to confirm its efficacy. Intraprostatic botulinum toxin A injections are the first treatment of BPH to target both the increase in smooth muscle tone (dynamic component) and the excessive growth (static component) of BPH. This approach of BPH is very promising but more studies with long-term follow up are needed.

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