New Endoscopic In-Office Surgical Therapies for Benign Prostatic Hyperplasia: A Systematic Review

A variety of minimally invasive surgical therapies for the treatment of benign prostatic hyperplasia (BPH) have been introduced in recent years with a significant shift towards outpatient procedures. Early studies suggest that these therapies provide adequate symptomatic relief while minimizing some of the disadvantages associated with standard surgical approaches. However, understanding their unique roles in the treatment landscape for BPH requires an appreciation of the varied protocols and outcomes that comprise these studies.

We therefore systematically reviewed all clinical trials on three promising technologies, specifically prostatic urethral lift (PUL), water vapor thermal therapy (WVTT), and temporary implantable nitinol device (TIND). We found that all three technologies provided symptomatic relief at short-term follow-up. Medium-term follow-up exists for PUL and WVTT although no head-to-head trials exist. The rates of serious or Clavien-Dindo grade III/IV complications were acceptably low among all modalities, with no clear pattern in rates or types of events. The rates of erectile and ejaculatory dysfunction were also low, although WVTT demonstrated a relatively higher risk for both.

All modalities may be performed in-office under sedation or local anesthesia. On average, patients receiving PUL required shorter durations of postoperative catheterization compared to those receiving WVTT. Although patients receiving TIND did not require postoperative catheterization, they underwent a device implantation period of approximately five days. Compared to TIND, PUL and WVTT offer higher rates of success for patients with obstructive median lobes. PUL and WVTT have also been shown to be effective in patients with chronic retention.

Overall, PUL, WVTT, and TIND represent promising additions to the current surgical armamentarium for BPH. Future studies comparing these technologies against standard surgical approaches and one another will provide greater clarity in their exact utility and the ideal target population.

Written by: Michael Tzeng; Spyridon P. Basourakos, MD; Patrick J. Lewicki, MD; Jim C. Hu, MD, MPH; Richard K. Lee, MD, MBA, Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.

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