Modern surgical techniques for the treatment of benign prostatic hyperplasia: a systematic review
Abstract
Aims: To systematically review randomized evidence on modern minimally invasive and endoscopic techniques for treating lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH), focusing on clinical efficacy, safety, perioperative outcomes, preservation of sexual/ejaculatory function, and durability compared with TURP or sham.
Methods: We conducted a systematic PubMed search (2020–2025) using predefined terms for BPH surgery and randomized controlled trials. Main findings from eligible articles were summarized.
Results: The review identified 41 randomized controlled trials evaluating nine modern techniques (endoscopic enucleation, laser vaporization, Aquablation, Rezūm water vapor thermal therapy, prostatic urethral lift/PUL, transperineal laser ablation/TPLA, temporary nitinol device/iTind, drug-coated balloon/Optilume, and prostatic artery embolisation/PAE), comprising thousands of men with moderate-to-severe LUTS. Endoscopic enucleation and Aquablation showed durable, TURP-like or superior improvements in IPSS, QoL, Qmax, and PVR, particularly in large prostates (>80 mL), with better perioperative outcomes. Minimally invasive surgical therapies (MISTs) provided meaningful symptom relief and excellent preservation of sexual/ejaculatory function, while PAE had lower objective efficacy and higher reintervention rates. Serious complications were uncommon across all techniques.
Conclusions: Current evidence supports these modern techniques as valuable…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
Read the paper
Related studies
- Treatment of non-metastatic castration-resistant prostate cancer: facing age-related comorbidities and drug–drug interactions
- The Efficacy of Flogofilm® in the Treatment of Chronic Bacterial Prostatitis as an Adjuvant to Antibiotic Therapy: A Randomized Prospective Trial
- Inhibition of growth and contraction in human prostate stromal cells by silencing of NUAK1 and -2, and by the presumed NUAK inhibitors HTH01-015 and WZ4003
- Effectiveness and Safety of a New Nutrient Fixed Combination Containing Pollen Extract Plus Teupolioside, in the Management of LUTS in Patients with Benign Prostatic Hypertrophy: A Pilot Study
- Extract from Cucurbita pepo improves BPH symptoms without affecting sexual function: a 24-month noninterventional study
- Aquablation vs. holmium laser enucleation of the prostate for benign prostatic hyperplasia: a 150-patients prospective comparative multicenter study
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.