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How I Handle Retreatment of LUTS Following a Failed MIST
Alexis E Te1, Ahra Cho2, Bilal I Chughtai2
1Department of Urology, Weill Cornell Medical College of Cornell University, 425 East 61st street, 12th floor, New York, NY, 10065, USA. aet2005@med.cornell.edu.
Current Urology Reports
|June 11, 2021
Summary
Minimally invasive treatment (MIST) failure is indicated by returning lower urinary tract symptoms (LUTS) or complications. Management involves monitoring, medication, or further procedures based on bladder function assessment.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Medical Technology
Background:
- Minimally invasive treatment (MIST) offers alternatives for various conditions.
- Treatment failure can manifest as persistent or recurrent symptoms and complications.
- Understanding MIST failure is crucial for effective patient management.
Purpose of the Study:
- To review retreatment strategies following failed minimally invasive treatments (MIST).
- To explore diverse technologies and their retreatment pathways.
Main Methods:
- Literature review of retreatment management after MIST failure.
- Analysis of diagnostic criteria for MIST failure.
- Evaluation of therapeutic options based on etiology and timing.
Main Results:
- MIST failure is defined by the return, persistence, or worsening of lower urinary tract symptoms (LUTS) or comorbidities like urinary tract infections (UTIs) and incontinence.
- Long-term bladder outlet obstruction (BOO) is a common cause of MIST failure impacting bladder function.
- Management strategies include monitoring, antimuscarinic/beta-agonist therapies for low post-void residual (PVR), or urodynamic studies and cystoscopy for high PVR to diagnose overactive bladder (OAB), BOO, or necrosis.
Conclusions:
- Failed MIST necessitates a tailored retreatment approach.
- Diagnostic evaluation, including PVR, urodynamics, and cystoscopy, guides subsequent interventions.
- Treatment options range from conservative management to surgical debulking, depending on the identified cause and severity.
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