Mechanical and Ablative Minimally Invasive Techniques for Male LUTS due to Benign Prostatic Obstruction: A Systematic Review according to BPH-6 Evaluation

Abstract

The treatment of male lower urinary tract symptoms (LUTS) due to benign prostatic obstruction represents one of the major interesting aspects in urological clinical practice. Although transurethral resection of the prostate is still considered the surgical gold standard for treatment of benign prostatic hyperplasia with prostate volume <80 mL, various minimally invasive surgical treatments (MITs) have been developed to overcome the limitations of the “conventional” surgery. To date, there are no validated tools to evaluate the surgical outcomes of MITs; however, in the past, BPH-6 has been used for this purpose. In this systematic review, we evaluated the efficacy and safety of MITs according to BPH-6 score system. We focused our attention on MITs based on mechanical devices (prostatic urethral lift and the temporary implantable nitinol device) and techniques for prostate ablation (image guided robotic waterjet ablation and convective water vapor energy ablation). Evidence shows that MITs are capable of leading to an improvement in LUTS without having an overwhelming impact on complications and are a valid alternative to other treatments in patients who wish to preserve their sexual function or in case of inapplicability of conventional surgery. However, comparative studies between these techniques are still missing.

Transperineal Laser Ablation of the Prostate (TPLA) for Lower Urinary Tract Symptoms Due to Benign Prostatic Obstruction

“…In this clinical scenario, EchoLaser TPLA has been introduced as a novel minimally-invasive procedure with favorable results across different settings [12][13][14][15][16][17][18]23]. Nonetheless, several systematic reviews are available for other techniques but, to the best of our knowledge, no previous literature review was specifically focused on TPLA [8][9][10]. Our paper reports an overview of the current management of patients treated with TPLA for BPH-including patient selection, perioperative and postoperative outcomes and complications-providing several insights for both clinicians and patients.…”

“…To date, preliminary studies have shown favorable perioperative and functional outcomes after TPLA for carefully selected patients with LUTS due to BPH. However, there is still no consensus regarding the treatment protocol, or the best indications for TPLA, and although a number of systematic reviews were previously conducted on surgical and functional outcomes of other uMISTs, to the best of our knowledge no review has specifically been focused on TPLA, yet [8][9][10].…”

A Novel Low-Cost Uroflowmetry for Patient Telemonitoring

“…In patients with moderate/severe symptoms and no complications, medical therapy is indicated [ 1 , 15 , 16 , 17 , 18 ]. Even if is beyond the scope of this article to describe the various treatment options [ 19 , 20 ], it is evident that constant and close objective monitoring of LUTS symptoms and therapeutic follow-up is highly needed [ 21 , 22 , 23 , 24 , 25 ]. Our home assessment device surely permits us to reach these goals better than the office-based one by offering the potential to provide cost-effective, high-quality, and constantly up-to-date data allowing for clinical decisions.…”