Urodynamic Outcomes After Aquablation.

OBJECTIVES: To compare urodynamic outcomes between Aquablation vs transurethral resection of the prostate (TURP). METHODS: Patients were randomized 2:1 (Aquablation:TURP) in the Waterjet Ablation Therapy for Endoscopic Resection of prostate tissue study. Urodynamics were measured at baseline and 6 months. RESULTS: Urodynamics studies were performed in 66 of the participating subjects at baseline and 6 month follow-up. At mean baseline pDet@qmax was 71 and 73cm H20 in the Aquablation and TURP groups, respectively (P = .7031). At 6-month follow-up, pDet@qmax decreased by 35 and 34cm H20, respectively (P < .0001 compared to baseline for both arms) with no significant difference in decrease across groups (P = .8919). A large negative shift in Bladder Outlet Obstruction Index was observed, consistent with a large reduction in the proportion of subjects with obstruction at follow-up compared to baseline (79% to 22% in Aquablation and 96% to 22% in TURP). CONCLUSIONS: In this trial, improvements after Aquablation in objective measures of bladder outlet obstruction were similar to those observed after TURP. ClinicalTrials.gov number, NCT02505919.

A Review of Laser Treatment for Symptomatic BPH (Benign Prostatic Hyperplasia).

Benign prostatic hyperplasia (BPH) is the predominant cause of bladder outflow obstruction and is associated with significant morbidity. Surgical removal of adenoma has been a key treatment principle for alleviation of obstruction. Lasers have been used as an alternative to transurethral resection of the prostate (TURP), due to the higher complications of the latter procedure, since the early 1990s. Early generations of lasers utilized coagulative and ablative techniques to dis-obstruct the bladder. Ablative techniques have remained popular with the resurgence of 532-nm vaporization (commonly known as GreenLight). Enucleation techniques especially with the holmium laser have shown durable efficacy in randomized controlled trials whilst new modalities such as thulium still require long-term data. This review examines the most common types of laser technology used in BPH surgery, with a focus on efficacy and side effect profile.

Evolving and investigational therapies for benign prostatic hyperplasia.

INTRODUCTION: Lower urinary tract symptoms (LUTS) are common and are often caused by benign prostatic hyperplasia (BPH). Traditional surgical methods of open enucleation and transurethral resection of prostrate (TURP) have been efficacious in alleviating these symptoms however, these are operator dependent and often come with significant side effects. In this review, we will discuss upcoming new surgical techniques in management of BPH. MATERIALS AND METHODS: A systematic search of SCOPUS, MEDLINE, EMBASE and Cochrane databases were carried out using relevant key words. RESULTS: Intra-prostatic injections with a variety of agents have been explored as these can be readily performed under local anesthesia. Alcohol injections into the prostate have been abandoned due to potential side effects but there has been ongoing development of two alternative agents, NX-1207 and PRX-302. Both have shown good safety profiles and early efficacy in phase II studies. Thermal treatment with the Rezum device performed as an outpatient procedure has shown both safety and efficacy in phase I and II studies. Aquablation shows promise in phase II studies with few side effects and is a relatively an automated procedure, albeit requiring general anesthesia. Prostate artery embolization has been reported in a number of studies, but clinical outcomes have been unpredictable. Histotripsy has had a number of complications in animal models and despite technical improvement has not yet progressed beyond feasibility studies in humans. CONCLUSIONS: Some of the new techniques and technologies available for BPH have been shown to be relatively safe and efficacious and await validation with phase III studies.