Aquablation, Gilling et al. (44 Gilling P, Reuther R, Kahokehr A, Fraundorfer M. Aquablation - image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 2016;117:923-9.) |
Men 45-80 years, Qmax ≤15, Prostate 30 - 80 cc by TRUS, IPSS ≥12 |
PVR >300 mL, Prostate/bladder cancer, Prior prostate surgery |
PUL, Roehrborn et al. (22 Hoffman RM, MacDonald R, Monga M, Wilt TJ. Transurethral microwave thermotherapy vs transurethral resection for treating benign prostatic hyperplasia: a systematic review. BJU Int. 2004;94:1031-6.) |
Men ≥ 50 years, Flow rate ≤12, VV ≥125 cc, AUASI ≥13, Prostate 30-80 cc, no prior surgical treatment for BPH, washouts of 2 weeks for a-blocker, 3 months for 5a-reductase inhibitor and 3 days for anticoagulants |
Obstructive median lobe, PVR >250 mL, Active UTI, PSA >10 ng/mL (unless negative biopsy) |
PUL, Sønksen et al. (1111 Sønksen J, Barber NJ, Speakman MJ, Berges R, Wetterauer U, Greene D, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study. Eur Urol. 2015;68:643-52.) |
Male ≥ 50 years, Qmax ≤15 mL/s for 125 mL voided volume, IPSS >12, PVR <350 mL Prostate volume ≤ 60 cc, Incontinence Severity Index score ≤4 |
Median lobe, Active UTI, Urinary retention, Prior prostate surgery |
CWVTT, McVary et al. (2323 McVary KT, Gange SN, Shore ND, Bolton DM, Cowan BE, Brown BT, et al. Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift. J Sex Med. 2014;11:279-87.) |
Male ≥50 years, Qmax 5 - 15 mL/s for 125 mL voided volume, IPSS ≥13, Prostate volume 30 – 80cc, No prior invasive prostate intervention |
PVR ≥250 mL, PSA ≥ 2.5 ng/mL, Active UTI |
PAE, Insausti et al. (2626 Insausti I, Sáez de Ocáriz A, Galbete A, Capdevila F, Solchaga S, Giral P, et al. Randomized Comparison of Prostatic Artery Embolization versus Transurethral Resection of the Prostate for Treatment of Benign Prostatic Hyperplasia. J Vasc Interv Radiol. 2020;31:882-90.) |
Male >60 years, Qmax ≤10 mL/s or urinary retention, IPSS was ≥ 8, (QoL) related to LUTS was ≥ 3, TURP was indicated, BPH-related LUTS refractory to medical treatment for at least 6 months or the patient could not tolerate medical treatment |
Advanced atherosclerosis, Tortuosity of the iliac arteries, GFR <30 mL/min, Neurogenic bladder, Prostate cancer |
PAE, Abt et al. (2525 Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338.) |
Male ≥ 40 years, Qmax <12 mL/s or urinary retention, IPSS was ≥ 8, Prostate 25 – 80 cc, QoL related to LUTS was ≥ 3, TURP indicated, refractory to medical treatment or not willing to undergo or continue medical treatment. |
Advanced atherosclerosis, Tortuosity of the iliac arteries, GFR <60 mL/min, Neurogenic bladder, Prostate cancer |
PAE, Gao et al. (2121 Gao YA, Huang Y, Zhang R, Yang YD, Zhang Q, Hou M, et al. Benign prostatic hyperplasia: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology. 2014;270:920-8.) |
Qmax ≤ 15, (IPSS) >7, Prostate 20-100cc, Failed medical therapy with a washout period of 2 or more weeks. |
Detrusor hyperactivity or hypocontractility at urodynamic study, Prostate cancer, Prior prostate surgery, PSA >4 ng/mL |
PAE, Pisco et al. (2828 Pisco JM, Bilhim T, Costa NV, Torres D, Pisco J, Pinheiro LC, et al. Randomised Clinical Trial of Prostatic Artery Embolisation Versus a Sham Procedure for Benign Prostatic Hyperplasia. Eur Urol. 2020;77:354-62.) |
Male >45 yr old, Qmax <12 mL/s; IPSS of ≥ 20 and a QoL score of ≥ 3 PV ≥ 40 cc; |
Prostatic arteries not feasible for PAE, Active UTI, Prior prostate surgery, |
PAE, Carnevale et al. (2424 Carnevale FC, Iscaife A, Yoshinaga EM, Moreira AM, Antunes AA, Srougi M. Transurethral Resection of the Prostate (TURP) Versus Original and PErFecTED Prostate Artery Embolization (PAE) Due to Benign Prostatic Hyperplasia (BPH): Preliminary Results of a Single Center, Prospective, Urodynamic-Controlled Analysis. Cardiovasc Intervent Radiol. 2016;39:44-52.) |
Male >45 yr old, IPSS >19, Prostate 30-90cc, bladder outlet obstruction (BOO) confirmed by urodynamic examination |
Renal failure, suspected prostate cancer, neurogenic bladder disorder |
TIND, Chughtai et al. (2727 Chughtai B, Elterman D, Shore N, Gittleman M, Motola J, Pike S, et al. The iTind Temporarily Implanted Nitinol Device for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Multicenter, Randomized, Controlled Trial. Urology. 2021;153:270-6.) |
Male ≥ 50 yr old, Qmax ≤ 12 mL/s, with 125mL voided volume, IPSS of ≥10, PV 25-75 cc; |
PVR > 250mL, obstructive median lobe, PSA >10ng/mL or free PSA < 25% without a subsequent negative biopsy, previous prostate surgery. |