Minimally Invasive Surgical Approaches for Bladder Outlet Obstruction Within an Office Environment: A Comprehensive Literature Review
Abstract
Benign prostatic hyperplasia (BPH) is a common urological disorder in aging men, leading to bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS). Traditional surgical treatments are associated with hospitalization, general anesthesia, and potential sexual dysfunction. Minimally invasive surgical techniques (MISTs), such as Rezum, UroLift, and iTIND, offer office-based, local anesthesia options with fewer adverse events. This systematic review evaluates the efficacy, safety, and durability of these MIST procedures. A systematic search of OVID Medline and Embase was conducted in July 2024 using Boolean operators with terms related to BPH and MIST procedures. Inclusion criteria included English language studies using MIST with a minimum follow-up of 1 year. Data were extracted and analyzed, focusing on functional outcomes, retreatment rates, complications, and anesthesia use. Thirteen studies met inclusion criteria, with a total of 1,864 patients (Rezum 6 studies, 1,292 patients; UroLift 4 studies, 331 patients; and iTIND 3 studies, 241 patients). Rezum, UroLift, and iTIND all demonstrated significant improvements in Qmax and International Prostate Symptom Score (IPSS). Sexual function remained largely preserved. While retreatment rates varied, UroLift had the highest rate (mean: 6.4%). Procedural complications were generally mild, with acute urinary retention being the most frequent. Rezum, UroLift, and iTIND can be done safely and successfully as a day…
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