Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH.
However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function.
In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies.
Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function.
Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.
Prostate cancer and prostatic diseases. 2023 Apr 20 [Epub ahead of print]
David-Dan Nguyen, Tiange Li, Roseanne Ferreira, Mohamad Baker Berjaoui, Anna-Lisa V Nguyen, Bilal Chughtai, Kevin C Zorn, Naeem Bhojani, Dean Elterman
Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada., Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada., Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., Department of Urology, Weill Cornell Medical College, New York, NY, USA., Division of Urology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, QC, Canada., Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada. .
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37081044
Go Beyond the Abstract and Read a Commentary by the Authors