2023 AUA: Dr. Krambeck recaps the BPH update

In this video, Amy E. Krambeck, MD, highlights key takeaways from the BPH Update, which was presented at the 2023 American Urological Association Annual Meeting in Chicago, Illinois. Krambeck is a professor of Urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Video Transcript:

The BPH update was presented at the Brazilian and Portuguese Urology Society meeting. We really focused on how the treatment of BPH has changed in the last 5 to 10 years. We're seeing an introduction of minimally invasive surgical therapies, what we call MISTs, and that's bridging the gap between medication therapy and actual surgery. The problem with the MIST therapies is that they lack longevity, so they have a high retreatment rate with either medication or surgery. It's also taking away cases from surgery residents, such as transurethral resection or TURP cases. So their training is decreasing in this area, so the outcomes of the surgical interventions are not as good as what they used to be. It's definitely changing. Reimbursement is going up for the MIST therapies, and so we're paying more money for procedures that are less effective.

Also in the update, we talked about the benefits of surgical resection, either it be TURP or enucleation. If you can properly train people how to do these procedures, you can give them a surgical outcome that's meant to last for life so that they don't need repeat surgery, repeat medication, it's safe with short catheterization times, can be performed, or at least enucleation can be performed, in the anticoagulated patient. Long-term, we should be focusing our efforts on surgical procedures that will last for the patient. One caveat is that surgical procedures do generally cause retrograde ejaculation, which the minimally invasive therapies do not. At the end of the presentation, we talked a lot about shared decision-making with the patient. You need to know what the priorities are for the patient. Is preservation of ejaculation important? If so, is it important enough to run the high risk of a retreatment? If they say yes, then maybe you do want to steer them towards minimally invasive therapies. But if they say retrograde ejaculation is not a concern to me, and I want a long-lasting procedure, then we steer them towards surgical intervention.

This transcription has been edited for clarity.