Search

Alia J Codelia-Anjum,1,* Mohamad Baker Berjaoui,2,* Adree Khondker,2 Dean Elterman,2 Kevin C Zorn,3 Naeem Bhojani,3 Lori B Lerner,4 Bilal Chughtai1 1Department of Urology, Weill Cornell Medical College/New York Presbyterian, New York, NY, USA; 2Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada; 3Division of Urology, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada; 4Department of Urology, VA Boston Healthcare System, Boston, MA, USA*These authors contributed equally to this workCorrespondence: Bilal Chughtai, Weill Cornell Medical Center, Department of Urology, 425 East 61st Street, 12th Floor, New York, NY, 10065, USA, Tel +1 646 962-4811, Email bic9008@med.cornell.eduObjective: We set out to review studies reporting on the use of surgical intervention to treat Benign Prostatic Hyperplasia in elderly men ≥ 70 years of age.Methods: A systematic literature search was conducted using Scopus, PubMed-MEDLINE, Cochrane, and Wiley Online Library databases including studies published between January 2012 through December 2022. This 10-year interval was chosen given the recent plethora of new modalities that have entered the BPH armamentarium, many of which have been marketed as appropriate for older and high-risk patients. The following database search words were used either individually or in conjunction: “BPH”, “elderly”, “surgical”, “ablation”, “resection”, “embolization”, and “aging”.Results: We identified 28 studies for inclusion in this review. The pros and cons of these modalities are presented, specifically as applicable to an older and higher risk population.Conclusion: There are a wide variety of surgical procedures available for surgically treating BPH in elderly men with varying states of health. Each of these comes with different risks and benefits, supporting that individualized approaches are important. Long-term data and further studies comparing modalities, specifically as regards the elderly and frail, would enhance our approaches to BPH treatment in this patient population.Keywords: benign prostatic hyperplasia, aging, elderly, surgical

Kevin T McVary,1 Bilal Chughtai,2 Larry E Miller,3 Samir K Bhattacharyya,4 Ryan A Dornbier,1 Dean S Elterman5 1Center for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA; 2Department of Urology, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA; 3Department of Biostatistics, Miller Scientific, Johnson City, TN, USA; 4Health Economics & Market Access, Boston Scientific, Marlborough, MA, USA; 5Division of Urology, University Health Network, Toronto, ON, CanadaCorrespondence: Kevin T McVaryCenter for Male Health, Department of Urology, Stritch School of Medicine, Loyola University Medical Center, 2160 S, First Ave, Maywood, IL 60153, USAEmail kmcvary@gmail.comAbstract: Lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) are highly prevalent in older men. The long-term clinical utility of lifestyle modification and oral medications for LUTS is limited. There is a great clinical need for safe, effective, and durable BPH therapies for men who unsuccessfully attempt conservative measures. Enthusiasm for transurethral resection of the prostate has declined due to surgical risk, high rates of postoperative sexual dysfunction, and the perceived invasive nature therein. Consequently, interest has grown in developing minimally invasive surgical treatments (MISTs) that are efficacious but with a more favorable risk profile in order to better align with patient preferences. This review evaluates currently available MISTs for BPH. Further, we critically examine a “Leave Nothing Behind” philosophy in MIST for BPH since implantation of permanent metallic devices may be associated with increased long-term failure rates.Keywords: benign prostatic hyperplasia, LUTS, minimally invasive surgical treatment, MIST, Rezum, UroLift