EURURO Vol. 72 No. 6

999 1030

curve, which would allow it to be disseminated quickly on a
population scale. Furthermore, the shorter ablation and
overall procedural time would allow patients with more
comorbidity to undergo the procedure, although they
would still need to undergo a general anaesthetic.
Lastly, the review evaluated PAE. While the data on this
technique are definitely limited, the authors of the review,
in our opinion, fail to focus their discussions on the
advantages of PAE over the other techniques mentioned in
the review —namely the ability of PAE to treat men with
large prostates (>100 g), potentially with indwelling
catheters, who are not sufficiently fit to undergo general
anaesthesia.
This last point in our view goes right to the heart of the
matter as to which technique is best, that being that there is
no one superior technique—no “one size” that fits all. Recent
advances have potentially brought us into an era of
“personalised medicine” where each man is individually
assessed and treatment tailored to individual needs. For
example, a young man in his 50s with a small prostate
without a middle lobe and a desire to maintain his sexual
function is likely to be best suited to the Urolift. A man with
a moderately enlarged prostate, potentially with a middle
lobe, and who is either not concerned with sexual function
or indeed has pre-existing erectile dysfunction may be best
suited to TURP, while a man with a 130 g large vascular
prostate is arguably best suited to laser enucleation of the
prostate or PAE if not sufficiently fit to undergo anaesthesia.
Longer-term results are required for all these new MITs, [2_TD$DIFF]
as much of the current literature are relatively small series
of highly selected well-motivated patients performed by
enthusiasts for the technique, and thus the results are not
necessarily applicable to all patients—a point which often
does not obviously come across in reporting. Real-life
comparison with gold-standard treatments needs to be
made with standard well-validated parameters. Once this is
done, if the procedure can be offered as a day case or the
need for anaesthesia can be avoided, patients may choose to
accept a compromise in efficacy or durability, especially if
there is preservation of sexual function. As such these
treatments may form a new level in the treatment
algorithm, after medical management but before TURP or
laser treatments.
In summary, this review provides the latest data on novel
technologies for the treatment of male LUTS. The decision
concerning which technique should be used to treat a man
with male LUTS should be individualised to the individual
needs of the particular patient. Access to the whole range of
male LUTS treatments can only be of patient benefit.
Conflicts of interest: The authors have no relevant discloser.
References
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