MIST
Minimally Invasive Surgical Treaments

Minimally Invasive Surgical Therapies (MIST) for BPH

The MIST category of benign prostate hyperplasia treatments includes procedures can be done right in the doctor’s office to eliminate excess prostate tissue.

Here we will summarize three minimally invasive therapy options, which are established as potential options for many men suffering from the symptoms of BPH.

The Urolift and Rezūm Water Vapour Therapy are the MIST options most often applied by Dr. Zorn at SanoMed.

There are effective treatments available at SanoMed for prostate gland enlargement, including medications, minimally invasive therapies and surgery. To choose the best option, you and your doctor will consider your symptoms, the size of your prostate, other health conditions you might have, and your preferences.

The primary categories of treatment options are:

Please see below for more information on MIST options for BPH.

MIST BHP therapies are generally suited for men that do not want to take medication for BPH symptoms on an ongoing basis and cannot, or do not wish to undergo the risks of a standard surgical intervention. When satisfactory treatment results can be obtained with a MIST option this is usually preferable to the risks and side effects of surgery or medication.

This information is not intended to be an exhaustive list of all possible minimally invasive treatments for an enlarged prostate, but presents some common options for your information:

Rezūm Convective Water Vapour Energy Ablation

How Does Rezūm Treat BPH?

Rezūm Water Vapour Therapy is a minimally invasive procedure that uses the natural energy stored in a few drops of water to treat the excess prostate tissue causing BPH symptoms.

The doctor will use a hand-held device that passes through the urethra to reach the prostate. A tiny amount of steam is injected into the prostate to ablate (destroy) part of the swollen prostate tissue that is putting pressure on the urethra and causing the bothersome symptoms of BPH.

Rezūm is a transurethral needle ablation method that differs from the traditional TUNA, which delivers heat to the excess tissue in the prostate, and instead provides radiofrequency generated thermal energy in the form of water vapour.

The energy transported by the water damages the offensive cells, which in turn causes them to die. Over time, the body absorbs the treated tissue as part of the natural healing process, and as it does, symptoms of BPH are relieved.

Clinical data has shown that the Rezūm Water Vapour Therapy is safe and effective in relieving lower urinary tract symptoms due to BPH without compromising sexual function – and the treatment appears effective for at least two years. The goal of the treatment is to relieve symptoms so you can get back to your life and resume your daily activities.

Since use of the procedure is relatively new, there are no long-term studies to show if it will continue to provide effective symptom relief beyond two years. Until more physicians are trained in the technique, there are a limited number of Canadian clinics where men have access to Rezūm, including SanoMed.

The CUA describes Rezūm as a new and emerging therapy in the 2018 guideline on male lower urinary tract symptoms/benign prostatic hyperplasia, which states:
Ablation using the Rezūm® system (uses the thermodynamic principle of convective energy transfer), report significant improvement of IPSS and Qmax at three months and sustained until 12 months with preservation of erectile and ejaculatory function.

Reported two-year results have confirmed durability of the positive clinical outcome.

We suggest that Rezūm system of convective water vapour energy ablation may be considered an alternative treatment for men with LUTS interested in preserving ejaculatory function, with prostates <80 cc, including those with median lobe (conditional recommendation based on moderate-quality evidence).

Potential risks include but are not limited to painful urination (dysuria), blood in the urine (hematuria), blood in the semen (hematospermia), decrease in ejaculatory volume, suspected urinary tract infection (UTI), and urinary frequency, retention or urgency.
Rezūm® has been proven to reduce urinary symptoms for many men who have been diagnosed with an enlarged prostate, or benign prostatic hyperplasia (BPH).

As a minimally invasive procedure, Rezūm® has demonstrated fewer side effects compared to those typically seen with surgical therapies, but as with any interventional procedure, some of the following side effects may temporarily occur:

  • Painful urination
  • Blood in urine
  • Blood in semen
  • Frequent urination
  • Inability to urinate or completely empty the bladder
  • Need for short-term catheterization

Most of these events resolve within three weeks of the procedure, but there is a possibility some of these effects may be prolonged.

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Learn More About Rezūm Procedure
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Learn More About UroLift Procedure

Prostatic Urethral Lift - Urolift®

How Does Urolift® Treat BPH?

The Urolift® treatment can offer rapid relief from BPH. Tiny implants are used to hold open the obstructed pathway that blocks urine flow. Unlike medications, the UroLift System treatment addresses the blockage directly, offering a mechanical solution to a mechanical problem.

The UroLift System is the only treatment that uses the Prostatic Urethral Lift (PUL) procedure. The UroLift System treatment is a minimally invasive approach for treating lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) that can get men off BPH medications and avoid major surgery.

The UroLift System’s permanent implants, delivered during a minimally invasive outpatient procedure, relieve prostate obstruction and open the urethra directly without cutting, heating, or removing prostate tissue.

Typically those patients who respond well to this surgery are those whose prostate is not very enlarged. It may suit men who wish to minimise the sexual side effects experienced from taking medication, and those men who find the side effects of conventional surgery unacceptable.

The CUA describes Urolift as a new and emerging therapy in the 2018 guideline on male lower urinary tract symptoms/benign prostatic hyperplasia, which states:

The prostatic urethral lift procedure or Urolift® (small, permanent, suture-based nitinol tabbed implants compress encroaching lateral lobes delivered under cystoscopic guidance) provides less effective, but adequate and durable improvements in IPSS and QMax compared to TURP while preserving sexual function (no reported retrograde ejaculation observed at 12 months)

Most complications are mild and resolve within four weeks. Surgical retreatment was 13.6% over five years.

We suggest that prostatic urethral lift (Urolift) may be considered an alternative treatment for men with LUTS interested in preserving ejaculatory function, with prostates <80 cc and no middle lobe (conditional recommendation based on moderate-quality evidence).

After the treatment, patients typically go home the same day without a catheter. There is minimal downtime post-treatment and many patients experience symptom relief in as early as 2 weeks.Patients may experience some urinary discomfort during the recovery period. The most common side effects may include blood in the urine, some pain or discomfort when urinating, some increased urge to go and discomfort in the pelvis that typically resolve within two to four weeks after the procedure.These are some of the more common side effects that may occur following the procedure:

  • Sensitivity when passing urine
  • Urinary frequency
  • Strong urge to pass urine at times
  • Minimal bleeding
  • General pelvic discomfort/pain
  • Urinary leakage (relatively uncommon) but linked to urge
  • Urinary tract infection (occurs in approximately 5% patients)
  • Side effects from the anaesthetic

In men treated with Urolift, 50% showed improvement in flow rate (twice that of drugs but less than after TURP or HoLEP) and a 50% improvement of reported symptoms (up to 2-3 times better than drugs, but less than TURP or HoLEP).

Transurethral Microwave Therapy (TUMT)

How Does TUMT Treat BPH?

Transurethral microwave therapy (TUMT) is an outpatient procedure to treat urinary symptoms caused by an enlarged prostate. It’s generally used for men with small to moderate sized prostates.

A small microwave antenna is inserted through the tip of your penis into the urethra. The doctor extends the antenna until it reaches the area of the urethra surrounded by the prostate. The antenna emits a dose of microwave energy that heats and destroys excess prostate tissue blocking urine flow.

TUMT is one of several minimally invasive treatment options for an enlarged prostate. To determine the right treatment in your case, your doctor will consider the severity of your symptoms, any other health problems you have, and the size and shape of your prostate.

TUMT can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn’t allow their blood to clot normally. It is generally done on an outpatient basis and might be a safer option than surgery if you have certain other health problems.

TUMT is also less likely than some other BPH treatments to cause the release of semen into the bladder during ejaculation instead of out the body through the penis (retrograde ejaculation). This isn’t harmful but can interfere with your ability to father a child, so this MIST option could be considered if you wish to have children.

The CUA describes TUMT as a standard option in the 2018 guideline on male lower urinary tract symptoms/benign prostatic hyperplasia, which states:

Transurethral microwave therapy (TUMT) is a true outpatient procedure and an option for elderly patients with significant comorbidities or greater anaesthesia risks.

Although short-term success for LUTS improvement have been reported, the long-term durability of TUMT is limited with five-year cumulative retreatment rates between 42 and 59%.

We suggest TUMT therapy as a consideration for treatment of carefully selected, well-informed men (conditional recommendation based on moderate-quality evidence).

TUMT is generally safe with few if any major complications. You are typically able to go home after surgery. You may not be able to urinate and may need catheterization to drain your bladder. For most men, this lasts for a week or less. You can typically return to work 1 to 2 days after treatment and sexual activity can be resumed 1 to 2 weeks after surgery.

Potential side effects and risks include:

  • Blood in your urine. This shouldn’t last for more than a few days.
  • Irritating urinary symptoms. You might feel an urgent or frequent need to urinate, or you might have to get up more often during the night to urinate. Most men experience burning, especially at the tip of the penis and near the end of urination. These symptoms generally last about a week.
  • Difficulty holding urine. Incontinence can occur because your bladder is used to having to push urine through a urethra narrowed by enlarged prostate tissue. For most men, this issue improves with time.
  • Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. The risk of infection increases the longer you have a catheter in place.
  • New onset or worsening urinary symptoms. Sometimes TUMT can result in chronic inflammation within the prostate. The inflammation can cause symptoms such as a frequent or urgent need to urinate, and painful urination.
  • Need for re-treatment. TUMT might be less effective on urinary symptoms than other minimally invasive treatments or surgery. You might need to be treated again with another BPH therapy.

Additional BPH Treatments

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