Minimally invasive BPH treatments: Many options, all with advantages, disadvantages

Urologists currently have several minimally invasive surgical therapies (MIST) for the treatment of BPH, but each has advantages and disadvantages that must be considered before initiating treatment. Newer MIST modalities tend to fall somewhere between the old standby of transurethral resection of the prostate and medical therapy, according to presenter Kevin T. McVary, MD, of the Feinberg School of Medicine, Northwestern University, Chicago.

"One of the major reasons patients participate in the procedures is that they perceive these newer modalities as having a reduced risk compared to TURP," Dr. McVary said.

When compared to TURP, transurethral need ablation (TUNA) has definite safety advantages.

"At least in terms of adverse events, TUNA really does fit the criteria for fewer events," according to Dr. McVary. "There's less erectile dysfunction, urinary incontinence, urethral strictures, and retreatment, and no reports of retrograde ejaculation [J Urol 2004; 171:2336-40]."

Transurethral microwave thermotherapy (TUMT) also offers important advantages.

"There is some symptom and, depending on which device, flow rate improvement," Dr. McVary said. "Longer-term data is also available for some of the devices."

However, MIST for BPH does have disadvantages. Storage symptoms can worsen in the first 2 to 3 weeks following TUMT, which can be very upsetting for patients. Also, the lack of tissue removal can be a disappointing in relation to longer-term management of the patient. There is also some question about the durability of the treatments.

"Despite initial high rates of satisfaction, if you follow these patients long term, you see that satisfaction erode," Dr. McVary said. "If we're doing these therapies to rid patients of medication, the necessity of them after the procedures should be considered a failure."

In order to maximize the effectiveness of MIST treatments and avoid the downsides, Dr. McVary recommends examining the patient's needs and using the most appropriate method.

"For bigger prostates without middle lobes, I'd treat with TUMT. If it's a [slightly] smaller prostate, a TUNA is nice and easy and I don't have to worry about delivering heat where I don't want to."