Pham Hannah, Sharma Pranav
Department of Urology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.
Can J Urol. 2018 Apr;25(2):9228-9237.
Oral therapy with alpha-blockers or 5-alpha reductase inhibitors remains the most common treatment in men with lower urinary tract symptoms (LUTS) secondary to benign prostatic hypertrophy (BPH). For patients who progress or fail medical therapy, the standard of care surgical treatment continues to be transurethral resection of the prostate (TURP), which has long-studied and durable outcomes. Emerging, minimally invasive options for LUTS secondary to the BPH, however, have been developed over the last decade with promising results and minimal side effects typically associated with TURP, such as retrograde ejaculation and erectile dysfunction.
We performed a literature review on PubMed over the last 10 years using keywords such as 'lower urinary tract symptoms,' 'benign prostatic hypertrophy,' 'minimally invasive,' and 'outpatient.' All relevant studies that reported on important urinary endpoints were included for each newly-approved treatment option. Available literature across varying prostate volumes was presented.
Newly-approved therapies for BPH include new thermal energy sources (Rezum, aquablation), mechanical stenting (UroLift), prostate artery embolization, and injectable agents. These emerging techniques could be considered in patients where preservation of sexual function is a priority since they have demonstrated comparable urinary outcomes to medical therapy while causing no significant sexual dysfunction. Only prostate artery embolization has been extensively analyzed and proven efficacious in patients with > 80 g prostates who cannot undergo surgery.
We have summarized the newly-approved treatment options for men with LUTS secondary to BPH as an alternative to traditional medical or surgical therapy. As more minimally invasive, office-based technologies emerge, physician and patients will have the ability to choose a treatment that is more catered to patient expectations.
对于因良性前列腺增生（BPH）继发下尿路症状（LUTS）的男性患者，α受体阻滞剂或5α还原酶抑制剂的口服治疗仍然是最常见的治疗方法。对于病情进展或药物治疗失败的患者，标准的护理手术治疗仍然是经尿道前列腺切除术（TURP），该手术具有长期研究且持久的疗效。然而，在过去十年中，已经开发出了针对BPH继发LUTS的新兴微创治疗方案，其效果良好且副作用极小，而这些副作用通常与TURP相关，如逆行射精和勃起功能障碍。
我们在过去10年中使用“下尿路症状”、“良性前列腺增生”、“微创”和“门诊”等关键词在PubMed上进行了文献综述。对于每个新批准的治疗方案，纳入所有报告重要尿液终点的相关研究。展示了不同前列腺体积的现有文献。
新批准的BPH治疗方法包括新的热能来源（Rezum、水消融）、机械支架置入（UroLift）、前列腺动脉栓塞和注射剂。由于这些新兴技术已证明在尿液结局方面与药物治疗相当，同时不会导致明显的性功能障碍，因此对于优先考虑保留性功能的患者可以考虑使用。只有前列腺动脉栓塞在前列腺重量>80 g且无法接受手术的患者中得到了广泛分析并被证明有效。
我们总结了新批准的针对BPH继发LUTS男性患者的治疗方案，作为传统药物或手术治疗的替代方案。随着更多基于门诊的微创技术出现，医生和患者将有能力选择更符合患者期望的治疗方法。
