He noted that TUEP’s major disadvantage is that is has an associated learning curve, but also states that it is more efficacious, and improves patient quality of life better than TURP.
Dr. Kirpekar also pointed out upcoming therapies such as intra-glandular injection therapy; these include genetically-modified recombinant form of a native “pro-acrolysin” (functions by cell permeation and lysis, i.e. death and shrinkage) and botulinum toxin type A (Botox) which is known to reduce glandular volume and alpha-receptors. Other technologies include WAVE technology which is RF heating of few drops of water at 103 degrees Celsius causing cell rupture and resorption; also, histotripsy which creates micro bubbles leading to cell death and gland cavitation. Nevertheless, he notes that bipolar TURP will likely continue to be the standard until long-term data is collected regarding the aforementioned modalities.
He ended with describing how he personally would like his own prostate treated. If it were 40 grams, he would want bipolar TURP; if 100grams, then enucleation via bipolar or holmium laser; and if 200 grams, then open Millins / robotic transvesical.
Presented by: Deepak Kirpekar, MD, MMF Ratna A. Memorial Hospital
Written by Shoaib Safiullah, MS4 for UroToday.com