**8. Future approaches to BPH**

Increasing average life expectancy, especially due to better health care and better education of the population, make us believe that soon we shall have, seek for medical care, a greater number of people suffering from elderly diseases. The health burden of disorders such as BPH will be a major dome for research in the future.

Recent investigation is underway in this field, some basic and translational research is being done, in an attempt to better understand and treat this prevalent disease.

minimal risk of bleeding and blood transfusion, decreased risk of retrograde ejaculation, shorter operating time and hospital stay, and an importantly higher long-term failure rate. *Transurethral electrovapori*zation (TUVP) is a modification of TURP and TUIP, employing high electrical current to vaporize and coagulate the obstructive prostate tissue. Long-term efficacy is comparable with TURP, but high number of patients has been found to

*Transurethral needle ablation* (TUNA) is a simple and relatively inexpensive procedure which uses a needle to deliver high-frequency radio waves to destroy the enlarged prostatic tissue. TUNA is a successful treatment for small-sized gland and it poses a low or no risk for

*Transurethral microwave thermother*apy (TUMT) heats the prostate using a microwave antennae mounted on a urethral catheter (Thorpe and Neal 2003). TUMT has been found to be safe and cost effective, with reasonable improvement in urine flow rate and minimal

*Transurethral ethanol ablation of the prostate* (TEAP) has been recently introduced as a minimally invasive alternative treatment for patients with BPH. TEAP produces necrotic effect on prostatic tissues, leading to fibrosis and shrinkage. It is an effective minimally invasive treatment option for medically high-risk symptomatic patients with BPH that can be performed as an outpatient procedure under regional anesthesia (El-Husseiny and

*Laser prostatectomy*: four types of lasers have been used to treat LUTS, namely neodymium: yttrium-aluminum-garnet (Nd: YAG) laser, holmium YAG laser (Ho:YAG), potassium titanyl phosphate (KTP), and diode laser. It has been found to be safe and effective technique, with significant improvement in urinary flow rates and symptoms. Short surgery time, shorter catheter use, minimal blood loss and fluid absorption, decreased hospital stay, low erectile dysfunction rates, and bladder neck contractures are few of the advantages of laser prostatectomy over the TURP and other conventional techniques (Donovan, Peters et al. 2000; Bent, Kane et al. 2006). Laser surgery is specially indicated in patients receiving

*Transrectal HIFU* (high intensity focus ultrasonography) therapy is the only technique that provides non-invasive tissue ablation; however, general anesthesia or at least heavy intravenous sedation is required. Long-term efficacy is limited, with a treatment failure rate of approximately 10% per year.Significant increase in uroflow and a decrease in postvoid residual volume have been observed, but the cost is three times higher than that of TURP

Increasing average life expectancy, especially due to better health care and better education of the population, make us believe that soon we shall have, seek for medical care, a greater number of people suffering from elderly diseases. The health burden of disorders such as

Recent investigation is underway in this field, some basic and translational research is being

done, in an attempt to better understand and treat this prevalent disease.

anticoagulant therapy that want to maintain ejaculation or are unfit for TURP.

experience irritative side effects (Desautel, Burney et al. 1998).

incontinence and erectile dysfunction (Ramon, Lynch et al. 1997).

impairment on sexual function (Richter, Rotbard et al. 1993).

Buchholz 2011).

(Madersbacher, Kratzik et al. 1993).

**8. Future approaches to BPH** 

BPH will be a major dome for research in the future.

Recently Woo *et.* al reported the use of a Prostatic Urethral Lift (PUL) procedure, which is a novel, minimally invasive treatment for symptomatic benign prostatic hyperplasia (BPH). PUL aims to mechanically open the prostatic urethra without ablation or resection, with patients reporting sustained symptom relief for 12 months with minimal morbidity (Woo, Chin et al. 2011).

Tadalafil and other phosphodiesterase type 5 (PDE5) inhibitors have demonstrated beneficial effects on smooth muscle relaxation, smooth muscle and endothelial cell proliferation, nerve activity, and tissue perfusion that may impact LUTS (Andersson, de Groat et al. 2011). Consistent evidence of improvements in LUTS has been shown with PDE5-Is, either alone or in combination with α-blockers (Martinez-Salamanca, Carballido et al. 2011). However, urodynamic results or objective measures of urinary flow are lacking (Martinez-Salamanca, Carballido et al. 2011).

De Souza *et* al, investigated the effects of *Orbignya speciosa*, a nanoparticle extract, newly developed phytotheraphy that can be safely used on the management of BPH (de Souza, Palumbo et al. 2011).

In our country (Portugal) a recent study led by Pisco *et*. al, aimed to evaluate whether prostatic arterial embolization could be a feasible way to treat lower urinary tract symptoms associated with benign prostatic hyperplasia. Their preliminary results and short-term follow-up suggest good symptom control without sexual dysfunction associated with a reduction in prostate volume (Pisco, Pinheiro et al. 2011).

Rick *et* al, in recent times used growth hormone-releasing hormone (GHRH) in animal models. They concluded that GHRH antagonists can lower prostate weight in experimental BPH with significant reductions in protein levels of IL-1β, NF-κβ/p65, and cyclooxygenase-2 (COX-2), suggesting that GHRH antagonists should be considered for further investigation as therapy for BPH (Rick, Schally et al. 2011)

It is important in a near future to characterize a *clinical phenotype* of BPH; measure disease severity and outcomes; design clinical trials; study concepts for drug therapy, behavioral and lifestyle interventions and additional intervention therapies (AUA 2010).
