Chair: Francisco Cruz
Treatment of BPO remains a topic with unclear areas. If the onset of medical treatment has been extensively investigated, its duration and the criteria for its replacement by more invasive treatments is unclear. Some studies suggest that eventually due to an excessive length of medical treatment men submitted to invasive procedures are older, with more comorbidities and poor lower urinary tract function. The introduction of minimal invasive surgical treatments (MISTs) for BPO, with less complications and with a faster recovery while maintaining the efficacy of TURP or enucleation make the perpetuation of medical therapy even more questionable. But is there agreement that MISTs should be offered earlier than classical treatments? Can the procedures be used interchangeably or should they be chosen according to the prostate size and form and dominant symptoms? Should urodynamics be used before MISTs to demonstrate BPO, particularly if a trend to prostate tissue ablation at an early age becomes a routine?
It is expected that the attendees at the end of the RT will be more informed to manage male LUTS and BPO according to the latest scientific evidence.
Where is the limit for medical therapy in a man with BPO? - Kakizaki H 15m
Most men initiate medical treatment due to bothersome LUTS with alpha blockers, 5-alpha reductase inhibitors, PDE-5 inhibitors, antimuscarinics or beta3 agonists, isolated or in combination. Although alpha blockers may improve urodynamic demonstrated BOO, in real life the beginning of medical treatment is decided on the basis of LUTS severity. If the onset does not rise great controversies, the moment the treatment should be abandoned in favour a more effective, albeit invasive treatment is unclear. Should a clinician abandon medical treatment based solely on clinical progression or are there more subtle, precocious signs to take that decision?
Which are the frontiers for Aquablation, water vapour therapy and transperineal laser prostate ablation for the treatment of BPO? - Dean Elterman 15m
Minimal invasive surgical treatment (MIST) to BPO intend to introduce new surgical procedures with less complications and with a faster recovery while maintaining the efficacy of gold standard methods. Considering only the most studied ablative techniques, aquablation, water vapour therapy and transperineal laser ablation, some questions are still unanswered. Should these techniques be offered earlier than classical treatments? Can the procedures be used interchangeably or should they be used according to the prostate size and/or form? Is the preservation of ejaculation an objective with health value to justify MISTs? Are the long-term results equivalent to those of TURP?
How do I select patients for de-obstruction? - Enrico Finnazi Agro 15m
The UPSTREAM study showed that the systematic use of invasive urodynamics will not improve the outcome of TURP and will not decrease indications for prostate surgery. Nevertheless, a more fine sub analysis seems to indicate that specific groups of men may benefit from urodynamics, particularly by identifying unrecognized BPO. Should urodynamics by also used before MISTs, particularly if a trend to prostate tissue ablation at an early age becomes a routine?
Discussion - All 15m
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• Learning objectives
To improve the management of male LUTS associated with BPE/BPO