Este protocolo aborda o manejo dos sintomas do trato urinário inferior decorrentes de hiperplasia prostática benigna (STUI/HPB) em pacientes cuja terapia medicamentosa inicial não produziu alívio sintomático adequado — e que necessitam de um próximo passo estruturado.
A linha de tratamento anterior — um bloqueador alfa (alfuzosina, doxazosina, silodosina, tansulosina ou terazosina), ou tadalafila, ou tadalafila combinada com um bloqueador alfa — não alcançou uma redução superior a 3 pontos no Índice Internacional de Sintomas Prostáticos (IPSS) em relação ao valor basal dentro de 4 a 12 semanas. A falha em atingir esse limiar de alívio sintomático é a indicação para escalada para este protocolo.
O próximo passo envolve intervenção cirúrgica. Múltiplas opções procedimentais baseadas em evidências estão disponíveis, e a seleção depende de fatores como o volume da próstata e o contexto clínico individual. O algoritmo procedimental completo e os critérios detalhados para cada opção encontram-se no protocolo abaixo.
DOI: 10.1097/JU.0000000000003698
TURP should be offered as a treatment option for patients with LUTS/BPH.
Clinicians may use a monopolar or bipolar approach to TURP as a treatment option, depending on their expertise with these techniques.
TUIP should be offered as an option for patients with prostates ≤30g for the surgical treatment of LUTS/BPH.
PVP should be offered as an option using 120W or 180W platforms for the treatment of LUTS/BPH.
Holmium laser enucleation of the prostate (HoLEP) or thulium laser enucleation of the prostate (ThuLEP) should be considered as an option, depending on the clinician's expertise with these techniques, as prostate size-independent options for the treatment of LUTS/BPH.
Bipolar TUVP may be offered as an option to patients for the treatment of LUTS/BPH.
PUL should be considered as a treatment option for patients with LUTS/BPH provided prostate volume 30-80g and verified absence of an obstructive middle lobe.
WVTT should be considered as a treatment option for patients with LUTS/BPH provided prostate volume 30-80g.
Robotic waterjet treatment (RWT) may be offered as a treatment option to patients with LUTS/BPH provided prostate volume 30-80g.
Open, laparoscopic, or robotic assisted prostatectomy should be considered as treatment options by clinicians, depending on their expertise with these techniques, only in patients with large to very large prostates.
PAE may be offered for the treatment of LUTS/BPH.
TIPD may be offered as a treatment option for patients with LUTS/BPH provided prostate volume is between 25 and 75g and lack of obstructive median lobe.
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