Better Functional Outcomes with the Novel Ultra-minimally Invasive Surgical Treatments in Men with BPH
Introduction
The prevalence of benign prostatic hyperplasia (BPH) associated with lower urinary tract symptoms (LUTS) is significant in men between 45–74 yr, with a prevalence ranging from 8% to 80%. Although medical therapy is the first treatment choice, it is often associated with insufficient symptom control and adverse effects. Surgical techniques also are associated with complications and causes a significant impact on the sexual function. Hence, several novel ultra-minimally invasive surgical treatments (uMISTs) for BPH/benign prostatic obstruction (BPO) have been introduced with the objective of providing better symptom control without affecting the sexual function.
Aim
The perioperative and functional outcomes of recently introduced uMISTs have been assessed in men with BPH/BPO.
Method
Study Design
- Systematic review and meta-analysis
Treatment Strategy
- A systematic electronic literature search was conducted using Medline, Embase, Scopus, and Web of Science databases.
- The search strategy used the PICO (Patients, Intervention, Comparison, Outcome) criteria and article selection was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
- The baseline characteristics, urological parameters, perioperative variables, postoperative complications, impact on sexual function were recorded.
- The perioperative and functional outcomes were compared using pooled and cumulative analyses.
Endpoints
- International Prostate Symptom Score (IPSS)
- Maximum flow rate (Qmax)
- Postvoid residual volume (PVR)
- International Index of Erectile Function-5 [IIEF-5] score
- Male Sexual Health Questionnaire [MSHQ-EjD] - Ejaculatory Dysfunction bother and function scales; Sexual Health Inventory for Men [SHIM]),-
- IPSS-Quality of Life (QoL) questionnaire score
- Peri-operative Variables
Results
- The analysis included 48 studies which met the inclusion criteria out of the 3978 studies identified through the initial electronic search.
- A decrease in the pooled IPSS was observed with uMIST (IPSS; -9.81 points, -11.37 to -8.25 at 1 month; -13.13 points, 14.98 to -11.64 at 12 months).
- An overall improvement in Qmax was seen in the uMIST groups (from +3.66 ml/s at 1 month to +4.14 ml/s at 12 months).
- A significant improvement in PVR was observed (-10.10 ml to 7.71 at 12 months).
- uMIST were not associated with any negative impact with respect to scores for the International Index of Erectile Function-5, Male Sexual Health Questionnaire-Ejaculatory Dysfunction bother and function scales (overall postintervention change in pooled median score of 1.88, at the start of follow-up; and 1.04 after 1 yr), or the IPSS-Quality of Life questionnaire.
- The overall rate of complications was 29% with no significant differences among the techniques.
Conclusion
- The new ultra-minimally invasive surgical treatments (uMISTs) might offer fast and effective relief from lower urinary tract symptoms (LUTS) without negatively impacting the quality of life in men with benign prostatic hyperplasia (BPH).
- Steam injection, prostate artery embolization, intraprostatic injection of fexapotide triflutate, implantation of a prostatic urethral lift and the temporary implantable nitinol device (TIND) had a minimal impact on patients' sexual function with respect to baseline, especially with respect to preservation of ejaculation.
Eur Urol Open Sci. 2021 Sep 22; 33:28-41. Doi: 10.1016/j.euros.2021.08.009.
