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New Minimally Invasive Solutions for Benign Prostatic Obstruction (BPO) Management: A Position Paper from the UrOP (Urologi Ospedalità Gestione Privata) - Beyond the Abstract

In recent years, minimally invasive techniques for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) have gained interest. These innovative approaches aim to provide effective solutions while preserving sexual and ejaculatory function, providing an attractive alternative to conventional gold standard treatment.

Our position paper summarizes the available evidence for several of these minimally invasive procedures, including the “Leonardi Ejaculation Sparing Technique (LEST)”, Aquablation, Rezum, Trans-Perineal Laser Ablation of the prostate (TPLA), Urolift, and the temporarily implanted nitinol device (iTIND).

LEST, the minimally invasive technique with the longest follow-up (up to 12 years), resulted in a significant improvement in IPSS and Qmax at 3 and 12 months (59% and 67%; +179% and +163%, respectively), while antegrade ejaculation was preserved in about 80% of cases.

For all other techniques, the results are promising, but all the evidence is relatively recent and has a short follow-up period, which limits long-term reliability. One of the strengths of all these techniques is the preservation of ejaculatory function.

De novo erectile function is anecdotal and ejaculatory dysfunction is generally low (15.4% with LEST, 3-6% with Rezum, 26.7% with Aquablation. ITind and Urolift had no effect on ejaculatory dysfunction.

Another advantage from the perspective of national health facilities is the ability to perform some of these procedures, including Rezum, iTind, and Urolift, in an ambulatory setting, which may reduce pressure on long waiting lists for surgical treatments requiring hospitalization and post-operative care.

The most important point remains patient selection, which should take into account overall health, prostate volume, and a strong desire to preserve ejaculation.

As these techniques evolve, ongoing studies are needed to determine their value in the treatment of LUTS due to BPH. Clinical trials are currently underway comparing these procedures not only to transurethral resection of the prostate (TURP) (NCT05762198, NCT05840549) but also to various alternative treatments, including purely medical interventions.

In summary, these minimally invasive approaches are promising alternatives and have the potential to reshape the landscape of BPH treatment by offering more patient-tailored, effective, and less invasive options.

Written by: Rosario Leonardi,1 Francesca Ambrosini,2 Rafaela Malinaric,2 Angelo Cafarelli,3 Alessandro Calarco,4 Renzo Colombo,5 Ottavio De Cobelli,6 Ferdinando De Marco,7 Giovanni Ferrari,8 Giuseppe Ludovico,9 Stefano Pecoraro,10 Domenico Tuzzolo,11 Carlo Terrone,12 Guglielmo Mantica13

  1. Urologi Ospedalità Gestione Privata (UrOP); Casa di Cura Musumeci GECAS, Gravina di Catania.
  2. IRCCS Ospedale Policlinico San Martino, Genova.
  3. Urologi Ospedalità Gestione Privata (UrOP); Urology Unit, Villa Igea, Ancona.
  4. Urologi Ospedalità Gestione Privata (UrOP); Villa Pia Hospital, Via Folco Portinari 5, Rome.
  5. Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, Vita e Salute San Raffaele University, Milan.
  6. Urologi Ospedalità Gestione Privata (UrOP); Department of Urology, IEO European Institute of Oncology, IRCCS, Milan.
  7. Urologi Ospedalità Gestione Privata (UrOP); I.N.I. Grottaferrata, Roma.
  8. Urologi Ospedalità Gestione Privata (UrOP); Hesperia Hospital, Modena.
  9. Urologi Ospedalità Gestione Privata (UrOP); Ospedale Miulli, Acquaviva delle Fonti, Bari.
  10. Urologi Ospedalità Gestione Privata (UrOP); NEUROMED, Avellino.
  11. Urologi Ospedalità Gestione Privata (UrOP).
  12. IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
  13. Urologi Ospedalità Gestione Privata (UrOP); IRCCS Ospedale Policlinico San Martino, Genova; Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova.
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