<p><strong>Clinicians may offer RWT as an option for patients with prostates 80-150 cc for the treatment of LUTS/BPH. (<em>Expert Opinion</em>)</strong></p>
Discussion
Discussion
<p>A prospective open-label trial of RWT was performed on 101 men with prostates 80-150 cc and up to 5 years of follow-up. The study showed a significant durable improvement in IPSS and quality of life scores, with a reduction of 15.9 points and 3.3 points at 5 years, respectively. There were also significant and durable improvements in uroflowmetry with an average improvement in Q<sub>max</sub> of 9.2 mL/s at 5 years. The retreatment rate was relatively low, with 6% of patients getting placed on medical therapy and an additional 3% of patients requiring surgical retreatment.<sup>379</sup> Notably, there was a significant decrease in hemoglobin levels from baseline to discharge of 2.9 g/dL (p<0.0001), with 10 patients requiring a blood transfusion and 5 patients requiring an additional trip to the operating room for a fulguration.<sup>380</sup> Notably, regarding blood loss in this study, there was no formalized bladder neck cautery performed in these patients. This bleeding risk has been mitigated with the use of focal bladder neck cautery, which is now considered a standard part of the procedure.<sup>377</sup> Long-term, RWT had no incidences of bladder neck contractures, urethral strictures, or meatal stenosis repaired during the 5 years of follow-up.<sup>379</sup> EjD was reported to be 19% in sexually active men at 12 months, with limited information beyond this 12-month period.<sup>380</sup> Given the lack of a comparator in these studies, counseling should reflect that comparative efficacy and durability are unknown. There was a meta-analysis with 425 men who underwent RWT and the patients were separated into two groups; men with prostates ≥100 cc or <100 cc. Both groups showed significant improvement in IPSS with an overall surgical retreatment rate of 0.7% at one year.<sup>381</sup></p>
<p>Evidence for RWT for prostates >150 cc is limited, therefore the Panel cannot provide any guidance for the use of RWT in these cases. </p>