Surgical Therapies for BPH
A nice meta-analysis comparing side effect profile of BPH interventions occurred in 2019 and focused on ejaculation effects. (4)
GREEN LIGHT PVP VS. TURP
The RCT GOLIATH study of 291 patients showed maximum urinary flow rate, post-void residual urine volume, prostate volume and prostate specific antigen were not statistically different between the treatment arms at 12 months. The complication-free rate at 1 year was 84.6% after GreenLight XPS vs 80.5% after transurethral resection of the prostate. At 12 months 4 patients treated with GreenLight XPS and 4 who underwent transurethral resection of the prostate had unresolved urinary incontinence. (1) A 2016 study of 566 men who underwent green light PVP showed 17.6% required repeat treatment at a mean of 9.2 months. The only variable shown to predict failure was peak flow rate of less than 15ml/sec immediately after removing urethral catheter post PVP. Average prostate size 48.5g in this study and size did not predict failure. (2)
ROBOTIC VS. OPEN SIMPLE PROSTATECTOMY
A RCT of 41 patients found the amount of blood loss during surgery was significantly lower in the robotic arm (539 vs 274 mL), but the operating time was significantly longer (134 vs 88 min). (3)
REZUM
PROSTATIC ARTERY EMBOLIZATION (PEA)
A nice meta-analysis reviewed the evidence for PEA in 2018. (5)
UROLIFT
Click here
GREEN LIGHT PVP VS. TURP
The RCT GOLIATH study of 291 patients showed maximum urinary flow rate, post-void residual urine volume, prostate volume and prostate specific antigen were not statistically different between the treatment arms at 12 months. The complication-free rate at 1 year was 84.6% after GreenLight XPS vs 80.5% after transurethral resection of the prostate. At 12 months 4 patients treated with GreenLight XPS and 4 who underwent transurethral resection of the prostate had unresolved urinary incontinence. (1) A 2016 study of 566 men who underwent green light PVP showed 17.6% required repeat treatment at a mean of 9.2 months. The only variable shown to predict failure was peak flow rate of less than 15ml/sec immediately after removing urethral catheter post PVP. Average prostate size 48.5g in this study and size did not predict failure. (2)
ROBOTIC VS. OPEN SIMPLE PROSTATECTOMY
A RCT of 41 patients found the amount of blood loss during surgery was significantly lower in the robotic arm (539 vs 274 mL), but the operating time was significantly longer (134 vs 88 min). (3)
REZUM
PROSTATIC ARTERY EMBOLIZATION (PEA)
A nice meta-analysis reviewed the evidence for PEA in 2018. (5)
UROLIFT
Click here
- Bachmann, Alexander, et al. "A European multicenter randomized noninferiority trial comparing 180 W GreenLight XPS laser vaporization and transurethral resection of the prostate for the treatment of benign prostatic obstruction: 12-month results of the GOLIATH study." The Journal of urology193.2 (2015): 570-578.
- Popeneciu, Ionel Valentin, et al. "Risk factors for long-term outcome in photoselective vaporization of the prostate." Scandinavian journal of urology 50.4 (2016): 313-318.
- Mourmouris, P., Keskin, S. M., Skolarikos, A., Argun, O. B., Karagiannis, A. A., Tufek, I., … Kural, A. R. (2019). A prospective comparative analysis of robot‐assisted vs open simple prostatectomy for benign prostatic hyperplasia. BJUI, 123(2), 313–317.
- Lebdai, Souhil, et al. "Do patients have to choose between ejaculation and miction? A systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment." World journal of urology 37.2 (2019): 299-308.
- Zumstein, Valentin, et al. "Prostatic artery embolization versus standard surgical treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a systematic review and meta-analysis." European urology focus (2018).