Minimal Invasive Surgical Techniques (MIST): wie relevant ist der ganze Mist?

Zusammenfassung

Aufgrund der steigenden Lebenserwartung und der wachsenden Nachfrage nach BPH-Behandlungen wurden innovative Technologien entwickelt, die eine zügige Erholung, Symptomlinderung, geringe Komplikationsraten sowie die Durchführung des Eingriffs ambulant und teilweise unter lokaler Betäubung ermöglichen. Das Ziel dieser Übersichtsarbeit ist es, die Ergebnisse der funktionellen Miktionsparameter und der sexuellen Funktion neu entwickelter minimalinvasiver chirurgischer Therapien (MIST) zur Behandlung der BPH zu beschreiben. Diese werden in primär ablative (Aquaablation [Aquabeam]), nicht-ablative (Prostata-Harnröhren-Lifting-Verfahren [PUL, Urolift], temporär implantierbare Körbchen [iTind]), und sekundär ablative Verfahren (konvektive Wasserdampfablation, Rezum, Prostataarterienembolisation [PAE]) unterschieden. Alle MIST-Technologien haben die medizinische Versorgung der BPH mit der Erhaltung der Ejakulation vorangetrieben. Langzeitdaten, die sich speziell mit Reinterventionsraten und den Erhalt der funktionellen Miktionsparameter beschäftigen, sind derzeit jedoch noch eine Seltenheit. Trotz vielversprechender Daten aus den Zulassungsstudien sowie aus randomisierten Studien, zeigen alle MIST-Therapien auch schwerwiegende Komplikationen. Patienten, die für eine solche Methode vorstellig werden, müssen über die Unterlegenheit im Gegensatz zu den etablierten transurethralen Verfahren wie die TUR-P und die Enukleation umfassend aufgeklärt werden.

Abstract

As life expectancy increases and there is growing demand for BPH treatments, innovative technologies have been developed, allowing for swift recovery, symptom relief, low complication rates, and the possibility of performing procedures on an outpatient basis, often under local anaesthesia. This review aims to describe the outcomes of newly developed minimally-invasive surgical therapies (MIST) for BPH treatment in terms of functional voiding parameters and sexual function. These therapies are categorized into primarily ablative (Aquablation [Aquabeam]), non-ablative (Prostatic Urethral Lift (PUL, Urolift), temporary implantable devices [iTind]), and secondarily ablative procedures (convective water vapor ablation, Rezum, Prostate Artery Embolization [PAE]). All MIST technologies have advanced the medical care of patients with BPH while preserving ejaculation. However, there is a shortage of long-term data specifically addressing re-intervention rates and the preservation of functional voiding parameters. Although there is promising data from regulatory trials and randomized studies, all MIST therapies are potentially associated with severe complications. Patients considering such methods must be thoroughly informed about their inferiority compared with established transurethral procedures like TUR-P and enucleation.

Schlüsselwörter

PUL - Aquaablation - PAE - iTind - Rezum

Keywords

PUL - Aquablation - PAE - iTind - Rezum

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