Christopher P. Smith, MD, MBA, MSS, presented “Minimally-Invasive BPH Therapies” during the 25th Innovations in Urologic Practice conference on September 26, 2021, in Santa Fe, New Mexico.
How to cite: Smith, Christopher P. “Minimally-Invasive BPH Therapies.” September 26th, 2021. Accessed Apr 2024. https://grandroundsinurology.com/minimally-invasive-bph-therapies/
Minimally-Invasive BPH Therapies – Summary
Christopher P. Smith, MD, MBA, MSS, Associate Professor of Urology at Baylor College of Medicine in Houston, Texas, considers data on prostatic urethral lift (PUL) and water vapor therapy for benign prostatic hypertrophy (BPH), and analyzes three case studies using the treatments. He begins with an overview of his case studies of men with BPH who all have an International Prostate Symptom Score (IPSS) above 19 and are on tamsulosin but are struggling with the lack of full relief and side effects of the medication. Dr. Smith then discusses the 2021 AUA guidelines for BPH treatment supporting the use of the IPSS at each patient visit to track symptoms and engage patients in early discussions of surgical options in the case of inadequate medications. He continues by summarizing data on the use and efficacy of PUL and water vapor therapy for BPH: a study on the adoption, safety, and retreatment rates of prostatic urethral lift found an increase in the use of the treatment of 10.4% from 2014 to 2018; PUL has passed GreenLight as a preferred procedure as of 2019, accounting for 30% of all BPH procedures; the L.I.F.T. trial and REZUM II trial found that PUL produced significant improvement in symptom scores, quality of life and flow rate when compared to a control; a prospective, randomized, multinational study of PUL versus transurethral resection (TUR) of the prostate found that PUL patients had a more rapid return to baseline activities than TUR patients by 6 days; the MedLift study showed that PUL patients experienced a 75% improvement in IPSS compared to a 34% improvement in control patients; PUL has also been found to have the lowest complications compared to Rezum, TURP, and GreenLight; a study comparing durability predictors after PUL found that men with worse disease states were found to need retreatment at higher rates; PUL is capable of improving ejaculatory function following treatment, while water vapor therapy reduces it; and there has been no recorded difference in outcomes between groups with or without prior prostate surgery. Dr. Smith concludes by stating that all three of his cases were treated with PUL, leading to their IPSS dropping to below 5 and them being taken off of medication.
About The 25th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Smith presented this talk at the 2021 conference.
For further educational activities from this conference, visit our collection page.
