A systematic review of novel surgical treatments for benign prostatic hyperplasia

Abstract

Background:

The range of surgical benign prostatic hyperplasia (BPH) treatments has hugely expanded in recent years. There is a need to keep up-to-date with ongoing innovations in BPH surgery, and critically appraise the new emerging treatments. The aim of this systematic review was to critically analyse the recent evidence for novel BPH therapies, not presently discussed in urological guidelines

Methods:

An initial scoping search was conducted to identify relevant BPH treatments for inclusion: Optilume^® BPH, transperineal laser ablation (TPLA), novel implantable nitinol devices, transurethral columnar balloon dilatation (TUCBD) and transurethral ultrasound ablation (TULSA). A systematic review was conducted of these treatments, searching MEDLINE, SCOPUS and PubMed databases, limited to within 5 years.

Results:

A total of 26 independent studies were included: 14 TPLA, 2 Optilume BPH, 2 TULSA, 5 TUCBD and 3 novel nitinol devices (ClearRing, Urocross Expander, Butterfly stent). For TPLA, most studies demonstrated significant improvement in efficacy outcomes in the absence of adverse events, although most trials were of small patient numbers with short follow-up. The highest quality evidence was presented by the randomised sham-controlled PINNACLE study for Optilume BPH, showing sustained significant International Prostate Symptom Score (IPSS) improvements at 2 years, and low retreatment rates. The evidence for TULSA was limited, showing unclear benefit and concerns about cost-effectiveness. The three novel nitinol device studies were of low evidence quality, with a high number of device-related events for the ClearRing and Butterfly implants. The Urocross Expander had a better safety profile, but limited efficacy data. The TUCBD studies showed contradictory outcomes, with possible confounding from combined bladder neck resection.

Conclusion:

This review has identified that TPLA and Optilume BPH appear to have the strongest evidence base and show promise as future BPH treatments. Further higher quality research is required for TULSA, TUCBD and novel nitinol devices.

Level of evidence:

2A