Neue minimalinvasive Therapieoptionen des benignen Prostatasyndroms

Zusammenfassung

Neue minimalinvasive Therapieansätze zur Behandlung des benignen Prostatasyndroms verfolgen das Ziel, bei gleichwertiger Wirksamkeit zu den etablierten Referenzverfahren ein günstigeres Sicherheitsprofil zu gewährleisten. Insbesondere der vollständige Erhalt der sexuellen Funktion, einschließlich der antegraden Ejakulation, ist von großem Interesse. Idealerweise lassen sich die neuen Prozeduren im ambulanten Setting unter lokaler Betäubung durchführen. Unter den mechanischen Ansätzen konnte für das Urolift^®-Verfahren in der kurz- und langfristigen klinischen Evaluierung eine signifikante Besserung der Symptome des unteren Harntraktes (lower urinary tract symptoms; LUTS) für ein selektives Patientengut ohne prominenten Mittellappen gezeigt werden. Dabei ist Urolift in Bezug auf den Erhalt der antegraden Ejakulation und einer kürzeren Rekonvaleszenz dem Referenzverfahren der transurethralen Resektion der Prostata (TURP) überlegen. In der ersten klinischen Beurteilung des „Temporary Implantable Nitinol Device“ (TIND) wurde die schnelle und einfache Durchführbarkeit der neuen Technik aufgezeigt mit ersten vielversprechenden Ergebnissen im 3-Jahres-Verlauf. Für eine adäquate Bewertung des Verfahrens stehen allerdings noch prospektive, randomisierte und kontrollierte Studien aus. Unter den neuen ablativen Verfahren demonstrierte die Verwendung von konvektivem Wasserdampf-Energietransfer in Form des Rezũm^®-Systems eine gute Wirksamkeit und Sicherheit in der 3-Jahres-Beurteilung. Es ist auch bei Vorhandensein eines obstruktiven Mittellappens einsetzbar und schont hierbei die antegrade Ejakulation. Innovative Ablationstechnologien wie die Aquablation (AquaBeam^®) stehen noch am Anfang ihrer klinischen Bewertung, doch zeigen bereits initiale klinische Studien vielversprechende Resultate, auch im direkten Vergleich mit der TURP.

Abstract

The main objective of novel minimally invasive treatment options is to be equally effective to current reference techniques while providing a superior safety profile. Especially the preservation of sexual function, including ejaculatory function, is of great interest to patients facing surgical treatment of lower urinary tract symptoms (LUTS). Ideally, a truly minimally invasive procedure can be performed under local anaesthesia in an outpatient setting. Among emerging medical devices, the prostatic urethral lift (PUL; Urolift) demonstrated rapid and durable relief of LUTS in selected patients without a prominent middle lobe. Compared to the reference method TURP, it was superior in terms of preservation of sexual function and recovery experience. The first clinical evaluation of the “Temporary Implantable Nitinol Device” (TIND) proved its feasibility, efficacy and safety for the treatment of LUTS over a 3-year follow-up period. However, prospective randomised controlled trials are still needed to evaluate its true benefit. New ablative technologies like Rezũm are based on convective water vapour energy and have shown good results in a sham-controlled randomised clinical trial for the treatment of LUTS over a follow-up period of 3 years. Of note, this procedure was also successful in patients with a prominent middle lobe, and no impairment of sexual function was reported after Rezũm. Innovative technologies like Aquablation (AquaBeam) are still in their infancy, but the first clinical outcomes are promising, even in comparison with the reference method TURP.

Schlüsselwörter

Benignes Prostatasyndrom - Benigne Prostatahyperplasie - Minimalinvasive Therapie

Keywords

male lower urinary tract symptoms - benign prostatic hyperplasia - minimally invasive treatment

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