National Trends in the Management of Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia
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BENIGN PROSTATIC HYPERPLASIA (K MCVARY, SECTION EDITOR)
National Trends in the Management of Lower Urinary Tract Symptoms Associated with Benign Prostatic Hyperplasia Joseph T. Mahon 1
&
Charles Welliver 2
Accepted: 15 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To gain an understanding of current practices in the management of lower urinary tract symptoms (LUTSs) in the setting of benign prostatic hyperplasia (BPH). Including both medication therapy and emerging minimally invasive options including peri-procedure considerations, expected outcomes, and value-based considerations. Recent Findings Medical therapy, primarily alpha blockers (ABs), and 5 alpha reductase inhibitors (5-ARI) remain the most commonly utilized intervention for LUTS associated with BPH. Several minimally invasive surgical treatments (MISTs) have emerged to provide efficacious and durable results, while largely sparing men from the sexual adverse effects of more invasive surgical options. The introduction of value-based health care has led to more cost-conscious medical care and is poised to influence the landscape of LUTS associated with BPH treatment. Summary As the population-based and societal needs continue to influence medical care for men with LUTS associated with BPH, a paradigm shift in management is expected. Keywords BPH . LUTS . Pharmacotherapy . MIST . Value-based care Abbreviations MIST Minimally invasive surgical treatment PUL Prostatic urethral lift BPH Benign prostatic hyperplasia LUTS Lower urinary tract symptoms TURP Transurethral resection of the prostate
Introduction The natural history of prostatic growth leads to an increasing prevalence as men age. Berry et al. [1] investigated the prevalence of histological evidence of BPH among autopsy specimen by age groups, finding that men exhibited an increasing prevalence with increasing age. More recent estimates suggest This article is part of the Topical Collection on Benign Prostatic Hyperplasia * Joseph T. Mahon [email protected] 1
Minnesota Urology PA, Minneapolis, MN, USA
2
Albany Medical Center, Albany, NY, USA
that nearly 70% of men aged 60–69 and 80% of men aged ≥ 70 have some degree of prostatic enlargement. It is not difficult to recognize BPH as a significant factor in the quality of life of men in America. In fact, it is not surprising that the prevalence and severity of LUTS also increase with through life with nearly 80% of men reporting measurable symptoms [2,3••]. A matter that is set to become only more common place. The US census bureau estimates that the number of Americans aged ≥ 65 years will nearly double by 2060, increasing the portion of the population from 52 million in 2018 to 95 million, thereby making up nearly 23% of the nation’s population (Fig. 1) [4]. Historically, options for treatment of men suffering from LUTS associated with BPH were limited, with men forced to choose between watchful waiting and open prostatectomy. With growing public awareness and patient outcry, the
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