PMID- 35475299
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220716
IS  - 2688-4526 (Electronic)
IS  - 2688-4526 (Linking)
VI  - 2
IP  - 4
DP  - 2021 Jul
TI  - Pharmacological and interventional treatment of benign prostatic obstruction: An 
      evidence-based comparative review.
PG  - 238-259
LID - 10.1002/bco2.74 [doi]
AB  - INTRODUCTION: The recommended treatment for bothersome lower urinary tract 
      symptoms (LUTS) secondary to benign prostatic obstruction (BPO) after the failure 
      of behavioral therapy and fluid modification includes pharmacological, minimally 
      invasive interventional, and surgical approaches. Each option has different risk 
      and benefit profiles, and the urologist must be aware of the unique 
      characteristics of each option in order to be able to accurately counsel the 
      patients based on their individual values and preferences. We provide a 
      comparative review of the commonest pharmacological and most widely performed 
      interventional/surgical treatments for BPO, discussing the evidence for the 
      treatment characteristics that are most useful for the practicing urologist. 
      METHODS: A search of the PubMed database was performed for articles reporting on 
      the following treatments for LUTS due to BPO: alpha-blockers, 5alpha-reductase 
      inhibitors, phosphpdiesterase-5 inhibitors, prostatic urethral lift (Urolift), 
      convective radiofrequency water vapor thermal therapy (Rezum), Temporary 
      implantable Nitinol Device (iTIND), prostate artery embolization (PAE), 
      transurethral resection of the prostate (TURP), photoselective vaporization of 
      the prostate (PVP), Aquablation, and anatomical endoscopic enucleation of the 
      prostate (AEEP). We performed a narrative review focussing on the following 
      outcomes: efficacy, safety, durability, duration of catheterization, length of 
      stay, re-treatment rate, efficacy in special situations (enlarged median lobe, 
      prostate size, urinary retention, and anticoagulant use), and sexual adverse 
      events. RESULTS: AEEP offers the greatest long-term improvement in maximum flow 
      rate, IPSS, and prostate volume reduction, with lowest re-treatment rate, 
      followed by PVP, TURP, and Aquablation. Urolift, Rezum, and PAE have similar 
      efficacy for prostate volume up to 80cc, and all are more effective than the 
      pharmacological treatment. Urolift offers the lowest rate of sexual dysfunction, 
      followed by Rezum, and both can be performed as a day case under local 
      anesthesia. CONCLUSION: Several treatment options exist to treat voiding LUTS due 
      to BPO. Newer minimally invasive treatments reduce the hospital stay and 
      postoperative complications, whereas AEEP provides the greatest long-term symptom 
      improvement at the expense of higher morbidity and sexual dysfunction. Men should 
      be counseled regarding all suitable treatment options as some may favor reduced 
      efficacy in association with reduced side effects.
CI  - (c) 2021 The Authors. BJUI Compass published by John Wiley & Sons Ltd on behalf of 
      BJU International Company.
FAU - Malde, Sachin
AU  - Malde S
AUID- ORCID: 0000-0002-3712-9460
AD  - Department of Urology Guy's and St Thomas' NHS Foundation Trust London UK.
FAU - Lam, Wayne
AU  - Lam W
AUID- ORCID: 0000-0001-5471-6117
AD  - Division of Urology Department of Surgery LKS Faculty of Medicine Queen Mary 
      Hospital The University of Hong Kong Hong Kong Hong Kong SAR.
FAU - Adwin, Zainal
AU  - Adwin Z
AUID- ORCID: 0000-0002-3685-4142
AD  - Department of Surgery Faculty of Medicine Universiti Teknologi MARA Selangor 
      Malaysia.
FAU - Hashim, Hashim
AU  - Hashim H
AD  - Bristol Urological Institute Southmead Hospital North Bristol NHS Trust Bristol 
      UK.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210203
PL  - United States
TA  - BJUI Compass
JT  - BJUI compass
JID - 101764975
PMC - PMC8988658
OTO - NOTNLM
OT  - Aquablation
OT  - Rezum
OT  - TURP
OT  - Urolift
OT  - benign prostatic enlargement
OT  - benign prostatic obstruction
OT  - embolization
OT  - laser
OT  - lower urinary tract symptoms
OT  - pharmacotherapy
COIS- The authors have no conflict of interest to declare related to this submission.
EDAT- 2021/02/03 00:00
MHDA- 2021/02/03 00:01
PMCR- 2021/02/03
CRDT- 2022/04/27 06:24
PHST- 2020/11/30 00:00 [received]
PHST- 2021/01/18 00:00 [revised]
PHST- 2021/01/18 00:00 [accepted]
PHST- 2022/04/27 06:24 [entrez]
PHST- 2021/02/03 00:00 [pubmed]
PHST- 2021/02/03 00:01 [medline]
PHST- 2021/02/03 00:00 [pmc-release]
AID - BCO274 [pii]
AID - 10.1002/bco2.74 [doi]
PST - epublish
SO  - BJUI Compass. 2021 Feb 3;2(4):238-259. doi: 10.1002/bco2.74. eCollection 2021 
      Jul.