Reimagining Male Lower Urinary Tract Symptoms Due to Benign Prostatic Hyperplasia Treatment: A New Approach to First-line Interventional Therapy - Beyond the Abstract
This novel terminology and treatment paradigm address critical gaps in the current management strategies for mLUTS. Traditionally, patients are offered a stepwise approach, beginning with lifestyle modifications and pharmacotherapy, and progressing to invasive surgical interventions only when symptoms persist or worsen.
However, this linear model often leaves patients navigating treatments that may be either insufficiently effective or overly invasive for their specific needs. FIT aims to bridge this divide by offering a minimally invasive, intermediary option that provides symptom relief with fewer side effects and shorter recovery times compared to surgery while surpassing the efficacy of medication. One of the primary motivations behind FIT is the recognition of the limitations of existing therapies. While pharmacological treatments remain the initial approach for many, their long-term efficacy can be modest, and side effects such as dizziness, sexual dysfunction, and fatigue can diminish adherence. On the other hand, surgical interventions, though capable of providing definitive relief, are often associated with significant risks, including bleeding, infection, and prolonged recovery periods. FIT reimagines this treatment landscape by introducing minimally invasive procedures earlier in the management algorithm.
These procedures, such as prostatic urethral lift (PUL) or novel technologies like drug-coated balloons, are designed to provide effective symptom relief while preserving patient quality of life. The term "First-line Interventional Therapy" underscores a strategic shift in how we approach BPH-related mLUTS. FIT emphasizes early intervention with therapies that are more personalized and balanced in their risk-benefit profiles. This paradigm aims to reduce the dependency on prolonged medication use, which can accumulate costs and side effects over time, and to delay or obviate the need for invasive surgery. By focusing on an intermediate solution, FIT aligns with the growing demand for patient-centered care, where treatment decisions are tailored to individual needs, preferences, and severity of symptoms. Furthermore, this approach reflects an understanding of the diverse clinical presentations of BPH, recognizing that not all patients benefit from a one-size-fits-all treatment pathway.
In introducing this terminology, we aim to catalyze a broader conversation within the field about optimizing the treatment continuum for mLUTS. FIT represents an evolution, not a revolution, in care—an approach that integrates existing minimally invasive technologies into a cohesive framework designed to fill the gaps between medication and surgery. By offering a balanced and effective option for a wide range of patients, FIT has the potential to enhance outcomes, improve patient satisfaction, and reduce the economic burden of BPH management on healthcare systems. We encourage our peers and colleagues to consider adopting FIT in clinical practice and integrating it into discussions about the future of BPH treatment.
This new framework not only provides a pathway for better patient care but also reflects the ongoing innovation and evolution in urology. Through FIT, we hope to empower clinicians to deliver more personalized, effective, and minimally invasive care for patients suffering from the burdens of BPH.
Written by: Dean Elterman, MD, MSc, FRCSC, Lang Family Endowed Chair in Urologic Innovation, Associate Professor, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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