Context

Lower urinary tract symptoms (LUTS) are one of the most common and troublesome nonmalignant conditions affecting quality of life in aging men. A spectrum of established medical and surgical options is available to provide relief of bothersome LUTS. Both the adverse events of medication and the morbidity with surgical treatment modalities have to be counterbalanced against efficacy. Novel minimally invasive treatment options aim to be effective, ideally to be performed in an ambulatory setting under local anaesthesia and to offer a more favourable safety profile than existing reference techniques.

Objective

A comprehensive, narrative review of novel minimally invasive treatment modalities for the management of male LUTS due to benign prostatic enlargement is presented.

Evidence acquisition

Medline, PubMed, Cochrane database, and Embase were screened for randomised controlled trials (RCTs), clinical trials, and reviews on novel minimally invasive treatment options for male LUTS due to benign prostatic enlargement.

Evidence synthesis

With regard to newly devised intraprostatic injectables (botulinum neurotoxin A, NX1207, PRX302), PRX302 is currently the only substance that was superior to placebo in a phase 3 RCT providing proof of efficacy and safety. The prostatic urethral lift technique has been evaluated in several phase 3 trials showing rapid and durable relief of LUTS without compromising sexual function in carefully selected patients without a prominent median lobe. The first clinical experience of the temporary implantable nitinol device demonstrated that implantation of this novel device is a safe procedure, easy, and fast to perform. Further studies are required to evaluate efficacy, durability, and to define appropriate patient selection. New ablative approaches like the image guided robotic waterjet ablation (AquaBeam) or procedures based on convective water vapour energy (Rezūm) are in the early stages of development. Prostatic artery embolization performed by interventional radiologists at specialised centres shows a high technical success rate in the treatment of bothersome LUTS. However, a substantial clinical failure rate and a particular spectrum of complications not commonly seen after urologic interventions do occur and need to be critically evaluated.

Conclusions

Initial promising clinical results on novel minimally invasive treatment options indicate efficacy comparable to standard techniques, often associated with a more favourable safety profile, in particular with preservation of sexual function. Many of these techniques are in their infancy and based on experience of new developments in the past. Further RCTs are required to evaluate efficacy, safety, and durability of novel techniques with long-term follow-up and careful evaluation of the selection criteria, which have been applied in clinical trials. The prostatic urethral lift is the only procedure with Level 1 evidence data and that can therefore be recommended for treatment of male LUTS in clinical practice for selected patients.

Patient summary

Minimally invasive treatment options have been developed to provide relief of lower urinary tract symptoms comparable to standard surgical techniques with a more favourable safety profile. However, long-term clinical evaluation is still needed for most of these innovations before they can be recommended to be an effective replacement for standard surgical treatment.

中文翻译：

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男性下泌尿道症状的新兴微创治疗选择

语境

下尿路症状（LUTS）是影响衰老男性生活质量的最常见，最麻烦的非恶性疾病之一。一系列已建立的医学和外科治疗方法可缓解烦恼的LUTS。药物的不良反应和手术方式的发病率都必须与疗效相抵消。新颖的微创治疗方案旨在有效，理想地在局部麻醉下的非卧床环境中进行，并提供比现有参考技术更有利的安全性。

客观的

介绍了一种新的微创治疗方法的综合叙述，该方法用于治疗由于前列腺增生引起的男性LUTS。

取证

筛选Medline，PubMed，Cochrane数据库和Embase的随机对照试验（RCT），临床试验，以及由于前列腺增生而对男性LUTS进行新的微创治疗的评论。

证据综合

对于新设计的前列腺内注射剂（肉毒杆菌神经毒素A，NX1207，PRX302），PRX302是目前唯一在3期RCT中优于安慰剂的物质，可提供功效和安全性证明。前列腺尿道举升技术已在几项3期试验中进行了评估，这些试验显示，经精心挑选且无明显正中叶的患者，LUTS可以快速持久地缓解LUTS，而不会损害性功能。临时植入式镍钛合金装置的首次临床经验表明，这种新型装置的植入是一种安全，容易且快速的手术过程。需要进一步的研究以评估疗效，持久性并确定合适的患者选择。像图像引导的机器人水射流消融（AquaBeam）或基于对流水蒸气能（Rezūm）的程序等新的消融方法仍处于开发的早期阶段。在专门中心由介入放射科医生进行的前列腺动脉栓塞术显示了在治疗烦人的LUTS方面的高技术成功率。然而，确实发生了严重的临床失败率和在泌尿外科干预后不常见的特殊并发症，需要对其进行严格评估。

结论

新型微创治疗方案的初步有希望的临床结果表明，其疗效可与标准技术相媲美，通常具有更佳的安全性，尤其是保留性功能。这些技术中的许多还处于起步阶段，并且基于过去的新开发经验。还需要进一步的RCT来评估新技术的功效，安全性和耐用性，并进行长期随访并仔细评估选择标准，这些已在临床试验中应用。前列腺尿道抬高术是唯一具有1级证据数据的程序，因此可以建议在某些患者的临床实践中推荐将其用于男性LUTS的治疗。

病人总结

已经开发出微创治疗选择，以提供与标准外科技术相当的下尿路症状缓解，并具有更有利的安全性。但是，大多数此类创新仍需要长期的临床评估，然后才能推荐它们作为标准手术治疗的有效替代方法。