<p><strong>Clinicians may offer IPDCB as an option for patients with prostates 20-80 cc, a prostatic urethral length 32-55 mm, and without an obstructing median lobe for the treatment of LUTS/BPH. (<em>Conditional Recommendation; Evidence Level: Grade C</em>)</strong></p>
Discussion
Discussion
<p>Established under outpatient sedation, but possible under local anesthetic, the IPDCB is a treatment validated in 20-80 cc prostates having a 32-55 mm prostatic urethral length, without a median lobe. It is a two-stage procedure, first utilizing a temporary dilating balloon to fracture the anterior prostatic commissure, and then exchanging this for a second paclitaxel-coated balloon that deposits the drug at the targeted tissues, which is selected from one of four sizes according to patient anatomy.<sup>385</sup> The treatment is contraindicated in the setting of paclitaxel hypersensitivity and patients are advised to abstain from sexual activity or utilize a condom for 30 days after treatment to minimize drug exposure to their partners (<a href="https://www.accessdata.fda.gov/cdrh_docs/pdf21/P210020B.pdf">https://www.accessdata.fda.gov/cdrh_docs/pdf21/P210020B.pdf</a>). As paclitaxel can persist in the semen for up to 12 months after the procedure, it is also recommended to avoid conceiving for at least 1 year after treatment.</p>
<p>Compared to sham, IPDCB provided significantly greater improvement in IPSS from 3-12 months, with no significant differences in sexual function.<sup>385</sup> Improvements from baseline IPSS and quality of life scores as well as objective measures of uroflowmetry and PVR bladder volume appear stable through two years of non-controlled observation.<sup>386</sup> Long-term durability remains unknown; however, similar non-controlled observational studies at 3-4 years have demonstrated a 1.3% surgical retreatment rate with some worsening of IPSS and quality of life scores, as well as objective measures of uroflowmetry and PVR bladder volume.<sup>387</sup><sup> </sup></p>