EURURO Vol. 72 No. 6

Platinum Priority – Review – Benign Prostatic Hyperplasia

Editorial by Rebecca L. Tregunna, Paul Cathcart and Matthew F. Bultitude on pp. 998–999 of this issue

Emerging Minimally Invasive Treatment Options for

Male Lower Urinary Tract Symptoms

Giuseppe Magistro

a , * ,

Christopher R. Chapple

b ,

Mostafa Elhilali

c ,

Peter Gilling

d ,

Kevin T. McVary

e ,

Claus G. Roehrborn

f ,

Christian G. Stief

a ,

Henry H. Woo

g ,

Christian Gratzke

Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany;

Department of Urology Research, University of Sheffield, Sheffield,

England, UK;

Department of Surgery, Division of Urology, Royal Victoria Hospital, McGill University Health Centre, Montreal, QC, Canada;

Tauranga

Hospital, Bay of Plenty District Health Board, Tauranga, New Zealand;

Division of Urology, Southern Illinois University School of Medicine, Springfield, IL,

USA;

Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA;

Sydney Adventist Hospital Clinical School, University of

Sydney, NSW, Australia

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 9 8 6 – 9 9 7

available at

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journal homepage:

www.europeanurology.com

Article info

Article history:

Accepted July 4, 2017

Associate Editor:

James Catto

Keywords:

Male lower urinary tract

symptoms

Benign prostatic hyperplasia

Minimally invasive treatment

Intraprostatic injection

Prostatic urethral lift

Temporary implantable nitinol

device

Waterjet ablation

Convective water vapour energy

Prostatic artery embolization

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Abstract

Context:

Lower urinary tract symptoms (LUTS) are one of the most common and

troublesome nonmalignant conditions affecting quality of life in aging men. A spectrum

of established medical and surgical options is available to provide relief of bothersome

LUTS. Both the adverse events of medication and the morbidity with surgical treatment

modalities have to be counterbalanced against efficacy. Novel minimally invasive

treatment options aim to be effective, ideally to be performed in an ambulatory setting

under local anaesthesia and to offer a more favourable safety profile than existing

reference techniques.

Objective:

A comprehensive, narrative review of novel minimally invasive treatment

modalities for the management of male LUTS due to benign prostatic enlargement is

presented.

Evidence acquisition:

Medline, PubMed, Cochrane database, and Embase were screened

for randomised controlled trials (RCTs), clinical trials, and reviews on novel minimally

invasive treatment options for male LUTS due to benign prostatic enlargement.

Evidence synthesis:

With regard to newly devised intraprostatic injectables (botulinum

neurotoxin A, NX1207, PRX302), PRX302 is currently the only substance that was

superior to placebo in a phase 3 RCT providing proof of efficacy and safety. The prostatic

urethral lift technique has been evaluated in several phase 3 trials showing rapid and

durable relief of LUTS without compromising sexual function in carefully selected

patients without a prominent median lobe. The first clinical experience of the temporary

implantable nitinol device demonstrated that implantation of this novel device is a safe

procedure, easy, and fast to perform. Further studies are required to evaluate efficacy,

durability, and to define appropriate patient selection. New ablative approaches like the

image guided robotic waterjet ablation (AquaBeam) or procedures based on convective

water vapour energy (Rezu- m) are in the early stages of development. Prostatic artery

embolization performed by interventional radiologists at specialised centres shows a

high technical success rate in the treatment of bothersome LUTS. However, a substantial

clinical failure rate and a particular spectrum of complications not commonly seen after

urologic interventions do occur and need to be critically evaluated.

* Corresponding author. Department of Urology, Ludwig-Maximilians-University of Munich,

Marchioninistraße 17, Mu¨ nchen 81377, Germany. Tel. +49894000.

E-mail address:

Giuseppe.Magistro@med.uni-muenchen.de

(G. Magistro).

http://dx.doi.org/10.1016/j.eururo.2017.07.005

0302-2838/