Treatment and technology trends in benign prostatic hyperplasia/hypertrophy (BPH)

Source: NKUDIC, National Institutes of Health

Benign prostatic hyperplasia or hypertrophy (BPH) is a pathologic condition characterized by a cellular proliferation of stromal and epithelial components. BPH is not life-threatening, but it can be uncomfortable, embarrassing, and inconvenient for the patient. No single definition of BPH has gained universal acceptance, making it difficult for epidemiologists to accurately calculate its incidence and prevalence. Histology, prostate size, symptoms of prostatism, urodynamic measurements, and performance of a prostatectomy may all be used to define BPH. It is a condition in which the prostate is enlarged, but not cancerous. As the prostate grows later in life, it can restrict the urethra and partially block the flow of urine. The wall of the bladder becomes irritable and begins to contract or shrink, even when it contains only a small amount of urine. This can cause the feeling of needing to urinate, even though the bladder isn’t full.

The physician may use a number of methods to determine if the patient has BPH. These can include a urine flow study, cystoscopy, ultrasound, or rectal exam. Urinary symptoms due to an enlarged prostate often develop slowly, and may include increased need to urinate, especially at night; sudden need to urinate; needing to strain in order to start the flow of urine; a urine stream that has become weak, variable or dribbling; pain or burning during urination; and the feeling that the bladder isn’t completely empty after urinating.

Current and Emerging Treatment Trends

Due in part to the side effects and complications associated with traditional BPH therapies, many patients diagnosed with BPH are regularly monitored by their physicians but elect not to receive active intervention. This course of inaction is known as ‘watchful waiting.’ If symptoms persist or worsen, drug therapy or surgical intervention has traditionally been recommended.

Drug therapy is usually the first line of treatment. There are seven well-recognized prescription drugs available in the USA for treating the symptoms of BPH: Flomax (Boehringer Ingelheim International GmbH), Hytrin (Abbott Laboratories), Cardura (Pfizer Inc.), UroXatral (Sanofi-Synthelabo), Rapaflo (Watson Pharmaceuticals, Inc.), Proscar (Merck & Co., Inc.) and Avodart (GlaxoSmithKline), some of which are now also available in generic preparation. It is estimated that more than 20% of patients who initially pursue drug therapy discontinue treatment within 12 months for various reasons including cost, ineffectiveness, side effects and the burdens of compliance. Patients may also try multiple drugs or combinations of drugs to improve effectiveness. This leads to a more costly treatment and often more side effects.

Symptoms and failure of medical management constitute the primary reasons to recommend surgical intervention, but deciding which intervention to choose can be difficult. Transurethral Resection of the Prostate (TURP) has long been considered the gold standard for surgical intervention. TURP is an invasive surgery in which portions of the prostatic urethra and surrounding tissue are removed, thereby widening the urethra and improving urinary flow. While TURP results in a dramatic improvement in urine flow and reduction in symptoms, the procedure can require a lengthy recovery time and is reported to have a high rate of side effects and complications. The TURP procedure also requires a highly skilled surgeon with extensive experience in performing the TURP.

There are quite a few newer procedures for treating BPH, most of them ablative in their mechanism of action, including electrical, RF, thermal, ultrasound, Botox, laser and Intraurethral stents. Ablative technologies include:

  • Transurethral Needal Ablation (TUNA)
  • Transurethral Microwave Thermal Therapy (TURP)
  • Transurethral Ablation Prostatectomy (TURAPY)
  • Holmium Laser Ablation of the Prostate (HoLAP)
  • Interstitial Laser Cagulation (ILC)
  • Ultrasound/High Intensity Focused Ultrasound (HIFU)
  • Water Intensity Hyperthermia (WIT)

For more information on clinical applications and markets for ablation technologies, see link.

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