Evolving and investigational therapies for benign prostatic hyperplasia

Lower urinary tract symptoms (LUTS) are common and are often caused by benign prostatic hyperplasia (BPH). Traditional surgical methods of open enucleation and transurethral resection of prostrate (TURP) have been efficacious in alleviating these symptoms however, these are operator dependent and often come with significant side effects. In this review, we will discuss upcoming new surgical techniques in management of BPH.

A systematic search of SCOPUS, MEDLINE, EMBASE and Cochrane databases were carried out using relevant key words.

Intra-prostatic injections with a variety of agents have been explored as these can be readily performed under local anesthesia. Alcohol injections into the prostate have been abandoned due to potential side effects but there has been ongoing development of two alternative agents, NX-1207 and PRX-302. Both have shown good safety profiles and early efficacy in phase II studies. Thermal treatment with the Rezum device performed as an outpatient procedure has shown both safety and efficacy in phase I and II studies. Aquablation shows promise in phase II studies with few side effects and is a relatively an automated procedure, albeit requiring general anesthesia. Prostate artery embolization has been reported in a number of studies, but clinical outcomes have been unpredictable. Histotripsy has had a number of complications in animal models and despite technical improvement has not yet progressed beyond feasibility studies in humans.

Some of the new techniques and technologies available for BPH have been shown to be relatively safe and efficacious and await validation with phase III studies.