The treatment of male lower urinary tract symptoms (LUTS) due to benign prostatic obstruction represents one of the major interesting aspects in urological clinical practice. Although transurethral resection of the prostate is still considered the surgical gold standard for treatment of benign prostatic hyperplasia with prostate volume <80 mL, various minimally invasive surgical treatments (MITs) have been developed to overcome the limitations of the “conventional” surgery. To date, there are no validated tools to evaluate the surgical outcomes of MITs; however, in the past, BPH-6 has been used for this purpose. In this systematic review, we evaluated the efficacy and safety of MITs according to BPH-6 score system. We focused our attention on MITs based on mechanical devices (prostatic urethral lift and the temporary implantable nitinol device) and techniques for prostate ablation (image guided robotic waterjet ablation and convective water vapor energy ablation). Evidence shows that MITs are capable of leading to an improvement in LUTS without having an overwhelming impact on complications and are a valid alternative to other treatments in patients who wish to preserve their sexual function or in case of inapplicability of conventional surgery. However, comparative studies between these techniques are still missing.

1.
McVary
KT
.
BPH: epidemiology and comorbidities
.
Am J Manag Care
.
2006 Apr
;
12
(
5 Suppl
):
S122
8
.
2.
Magistro
G
,
Weinhold
P
,
Stief
CG
,
Gratzke
C
.
The new kids on the block: Prostatic urethral lift (Urolift) and convective water vapor energy ablation (Rezūm)
.
Curr Opin Urol
.
2018 May
;
28
(
3
):
294
300
.
3.
Gratzke
C
,
Bachmann
A
,
Descazeaud
A
,
Drake
MJ
,
Madersbacher
S
,
Mamoulakis
C
,
EAU guidelines on the assessment of non-neurogenic male lower urinary tract symptoms including benign prostatic obstruction
.
Eur Urol
.
2015 Jun
;
67
(
6
):
1099
110
.
4.
Magistro
G
,
Chapple
CR
,
Elhilali
M
,
Gilling
P
,
McVary
KT
,
Roehrborn
CG
,
Emerging minimally invasive treatment options for male lower urinary tract symptoms
.
Eur Urol
.
2017 Dec
;
72
(
6
):
986
97
.
5.
Sountoulides
P
,
Karatzas
A
,
Gravas
S
.
Current and emerging mechanical minimally invasive therapies for benign prostatic obstruction
.
Ther Adv Urol
.
2019
;
11
:
1756287219828971
.
6.
Cimino
S
,
Voce
S
,
Palmieri
F
,
Favilla
V
,
Castelli
T
,
Privitera
S
,
Transurethral resection of the prostate (TURP) vs. GreenLight photoselective vaporization of benign prostatic hyperplasia: analysis of BPH6 outcomes after 1 year of follow-up
.
Int J Impot Res
.
2017
;
29
(
6
):
240
3
. .
7.
Gratzke
C
,
Barber
N
,
Speakman
MJ
,
Berges
R
,
Wetterauer
U
,
Greene
D
,
Prostatic urethral lift vs. transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study
.
BJU Int
.
2017
;
119
(
5
):
767
. .
8.
Sønksen
J
,
Barber
NJ
,
Speakman
MJ
,
Berges
R
,
Wetterauer
U
,
Greene
D
,
Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 study
.
Eur Urol
.
2015
;
68
(
4
):
643
. .
9.
Sterne
JA
,
Hernán
MA
,
Reeves
BC
,
Savović
J
,
Berkman
ND
,
Viswanathan
M
,
Risk of bias in non-randomized studies of interventions (ROBINS-I): detailed guidance
.
BMJ
.
2016 Oct 12
;
355
:
i4919
.
10.
Higgins
JP
,
Altman
DG
,
Gøtzsche
PC
,
Jüni
P
,
Moher
D
,
Oxman
AD
,
The cochrane collaboration’s tool for assessing risk of bias in randomised trials
.
BMJ
.
2011 Oct 18
;
343
:
d5928
.
11.
Porpiglia
F
,
Fiori
C
,
Bertolo
R
,
Garrou
D
,
Cattaneo
G
,
Amparore
D
.
Temporary implantable nitinol device (TIND): a novel, minimally invasive treatment for relief of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH): feasibility, safety and functional results at 1 year of follow-up
.
BJU Int
.
2015
;
116
(
2
):
278
. .
12.
Porpiglia
F
,
Fiori
C
,
Amparore
D
,
Kadner
G
,
Manit
A
,
Valerio
M
,
Second-generation of temporary implantable nitinol device for the relief of lower urinary tract symptoms due to benign prostatic hyperplasia: results of a prospective, multicentre study at 1 year of follow-up
.
BJU Int
.
2019 Jun
;
123
(
6
):
1061
9
.
13.
Porpiglia
F
,
Fiori
C
,
Bertolo
R
,
Giordano
A
,
Checcucci
E
,
Garrou
D
,
3-Year follow-up of temporary implantable nitinol device implantation for the treatment of benign prostatic obstruction
.
BJU Int
.
2018 Jul
;
122
(
1
):
106
12
.
14.
Kadner
G
,
Valerio
M
,
Giannakis
I
,
Manit
A
,
Lumen
N
,
Ho
BSH
,
Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2 year results of the MT-02-study
.
World J Urol
.
2020 Dec
;
38
(
12
):
3235
44
.
15.
Gilling
P
,
Reuther
R
,
Kahokehr
A
,
Fraundorfer
M
.
Aquablation: image-guided robot-assisted waterjet ablation of the prostate: Initial clinical experience
.
BJU Int
.
2016 Jun
;
117
(
6
):
923
9
.
16.
Gilling
P
,
Barber
N
,
Bidair
M
,
Anderson
P
,
Sutton
M
,
Aho
T
,
WATER: a double-blind, randomized, controlled trial of Aquablation® vs. transurethral resection of the prostate in benign prostatic hyperplasia
.
J Urol
.
2018 May
;
199
(
5
):
1252
61
.
17.
Gilling
P
,
Anderson
P
,
Tan
A
.
Aquablation of the prostate for symptomatic benign prostatic hyperplasia: 1-year results
.
J Urol
.
2017
;
197
(
6
):
1565
. .
18.
Misrai
V
,
Rijo
E
,
Zorn
KC
,
Barry-Delongchamps
N
,
Descazeaud
A
.
Waterjet ablation therapy for treating benign prostatic obstruction in patients with small- to medium-size glands: 12-month results of the first French Aquablation clinical registry
.
Eur Urol
.
2019 Nov
;
76
(
5
):
667
75
.
19.
Gilling
PJ
,
Barber
N
,
Bidair
M
,
Anderson
P
,
Sutton
M
,
Aho
T
,
Randomized controlled trial of aquablation versus transurethral resection of the prostate in benign prostatic hyperplasia: one-year outcomes
.
Urology
.
2019 Mar
;
125
:
169
73
.
20.
Gilling
P
,
Barber
N
,
Bidair
M
,
Anderson
P
,
Sutton
M
,
Aho
T
,
Two-year outcomes after aquablation compared to TURP: efficacy and ejaculatory improvements sustained
.
Adv Ther
.
2019 Jun
;
36
(
6
):
1326
36
.
21.
Kasivisvanathan
V
,
Hussain
M
.
Aquablation versus transurethral resection of the prostate: 1 year United States: cohort outcomes
.
Can J Urol
.
2018 Jun
;
25
(
3
):
9317
22
.
22.
Plante
M
,
Gilling
P
,
Barber
N
,
Bidair
M
,
Anderson
P
,
Sutton
M
,
Symptom relief and anejaculation after aquablation or transurethral resection of the prostate: subgroup analysis from a blinded randomized trial
.
BJU Int
.
2019 Apr
;
123
(
4
):
651
60
. .
23.
Gilling
P
,
Barber
N
,
Bidair
M
,
Anderson
P
,
Sutton
M
,
Aho
T
,
Three-year outcomes after aquablation therapy compared to TURP: results from a blinded randomized trial
.
Can J Urol
.
2020 Feb
;
27
(
1
):
10072
9
.
24.
Desai
MM
,
Singh
A
,
Abhishek
S
,
Laddha
A
,
Pandya
H
,
Ashrafi
AN
,
Aquablation therapy for symptomatic benign prostatic hyperplasia: a single-centre experience in 47 patients
.
BJU Int
.
2018 Jun
;
121
(
6
):
945
51
.
25.
Desai
M
,
Bidair
M
,
Bhojani
N
,
Trainer
A
,
Arther
A
,
Kramolowsky
E
,
“WATER II (80–150 mL) procedural outcomes
.
BJU Int
.
2019 Jan
;
123
(
1
):
106
12
.
26.
Yafi
FA
,
Tallman
CT
,
Seard
ML
,
Jordan
ML
.
Aquablation outcomes for the U.S. cohort of men with LUTS due to BPH in large prostates (80–150 cc)
.
Int J Impot Res
.
2018 Oct
;
30
(
5
):
209
14
.
27.
Zorn
KC
,
Goldenberg
SL
,
Paterson
R
,
So
A
,
Elterman
D
,
Bhojani
N
.
Aquablation among novice users in Canada: a WATER II subpopulation analysis
.
Can Urol Assoc J
.
2019 May
;
13
(
5
):
E113
8
.
28.
Desai
M
,
Bidair
M
,
Zorn
KC
,
Trainer
A
,
Arther
A
,
Kramolowsky
E
,
Aquablation for benign prostatic hyperplasia in large prostates (80–150 mL): 6-month results from the WATER II trial
.
BJU Int
.
2019 Aug
;
124
(
2
):
321
8
.
29.
Bhojani
N
,
Bidair
M
,
Zorn
KC
,
Trainer
A
,
Arther
A
,
Kramolowsky
E
,
Aquablation for benign prostatic hyperplasia in large prostates (80–150 cc): 1-year results
.
Urology
.
2019 Jul
;
129
:
1
7
.
30.
Bhojani
N
,
Nguyen
DD
,
Kaufman
RP
 Jr
,
Elterman
D
,
Zorn
KC
.
Comparison of <100 cc prostates and >100 cc prostates undergoing aquablation for benign prostatic hyperplasia
.
World J Urol
.
2019 Jul
;
37
(
7
):
1361
8
.
31.
Nguyen
DD
,
Barber
N
,
Bidair
M
,
Gilling
P
,
Anderson
P
,
Zorn
KC
,
Badlani
G
,
Waterjet ablation therapy for endoscopic resection of prostate tissue trial (WATER) vs. WATER II: comparing aquablation therapy for benign prostatic hyperplasia in 30–80 and 80–150 mL prostates
.
BJU Int
.
2020 Jan
;
125
(
1
):
112
22
.
32.
Chughtai
B
,
Thomas
D
.
Pooled aquablation results for American men with lower urinary tract symptoms due to benign prostatic hyperplasia in large prostates (60–150 cc)
.
Adv Ther
.
2018 Jun
;
35
(
6
):
832
8
.
33.
Bach
T
,
Giannakis
I
,
Bachmann
A
,
Fiori
C
,
Gomez-Sancha
F
,
Herrmann
TRW
,
Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort
.
World J Urol
.
2019 Jul
;
37
(
7
):
1369
75
.
34.
Eure
G
,
Gange
S
,
Walter
P
,
Khan
A
,
Chabert
C
,
Mueller
T
,
Real-world evidence of prostatic urethral lift confirms pivotal clinical study results: 2-year outcomes of a Retrospective Multicenter Study
.
J Endourol
.
2019 Jul
;
33
(
7
):
576
84
.
35.
Rukstalis
D
,
Grier
D
,
Stroup
SP
,
Tutrone
R
,
deSouza
E
,
Freedman
S
,
Prostatic Urethral Lift (PUL) for obstructive median lobes: 12 month results of the MedLift Study
.
Prostate Cancer Prostatic Dis
.
2019 Sep
;
22
(
3
):
411
9
.
36.
Schoenthaler
M
,
Sievert
KD
,
Schoeb
DS
,
Miernik
A
,
Kunit
T
,
Hein
S
,
Combined prostatic urethral lift and remodeling of the prostate and bladder neck: a modified transurethral approach in the treatment of symptomatic lower urinary tract obstruction
.
World J Uro
.
2018 Jul
;
36
(
7
):
1111
6
.
37.
Sievert
KD
,
Schoenthaler
M
,
Berges
R
,
Toomey
P
,
Drager
D
,
Herlemann
A
,
Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2 years
.
World J Urol
.
2019 Jul
;
37
(
7
):
1353
60
.
38.
Bozkurt
A
,
Karabakan
M
,
Keskin
E
,
Hirik
E
,
Balci
MB
,
Nuhoglu
B
.
“Prostatic urethral lift: a new minimally invasive treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia
.
Urol Int
.
2016
;
96
(
2
):
202
6
.
39.
Rukstalis
D
,
Rashid
P
,
Bogache
WK
,
Tutrone
RF
,
Barkin
J
,
Chin
PT
,
24-month durability after crossover to the prostatic urethral lift from randomised, blinded sham
.
BJU Int
.
2016
;
118
(
Suppl 3
):
14
. .
40.
Shore
N
,
Freedman
S
,
Gange
S
,
Moseley
W
,
Heron
S
,
Tutrone
R
,
Prospective multi-center study elucidating patient experience after prostatic urethral lift
.
Can J Urol
.
2014
;
21
(
1
):
7094
.
41.
Mcvary
KT
,
Gange
SN
,
Shore
ND
,
Bolton
DM
,
Cowan
BE
,
Brown
BT
,
Treatment of LUTS secondary to BPH while preserving sexual function: randomized controlled study of prostatic urethral lift
.
J Sex Med
.
2014 Jan
;
11
(
1
):
279
87
.
42.
Cantwell
AL
,
Bogache
WK
,
Richardson
SF
,
Tutrone
RF
,
Barkin
J
,
Fagelson
JE
,
Multicentre prospective crossover study of the “prostatic urethral lift” for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia
.
BJU Int
.
2014
;
113
(
4
):
615
.
43.
Roehrborn
CG
,
Barkin
J
,
Gange
SN
,
Shore
ND
,
Giddens
JL
,
Bolton
DM
,
Five year results of the prospective randomized controlled prostatic urethral L.I.F.T. study
.
Can J Urol
.
2017
;
24
(
3
):
8802
.
44.
Roehrborn
CG
,
Rukstalis
DB
,
Barkin
J
,
Gange
SN
,
Shore
ND
,
Giddens
JL
,
Three year results of the prostatic urethral L.I.F.T. study
.
Can J Urol
.
2015
;
22
(
3
):
7772
.
45.
Roehrborn
CG
,
Gange
SN
,
Shore
ND
,
Giddens
JL
,
Bolton
DM
,
Cowan
BE
,
The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the L.I.F.T. study
.
J Urol
.
2013 Dec
;
190
(
6
):
2161
7
.
46.
Chin
PT
,
Bolton
DM
,
Jack
G
,
Rashid
P
,
Thavaseelan
J
,
Yu
RJ
,
Prostatic urethral lift: two-year results after treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia
.
Urology
.
2012
;
79
(
1
):
5
. .
47.
Woo
HH
,
Chin
PT
,
McNicholas
TA
,
Gill
HS
,
Plante
MK
,
Bruskewitz
RC
,
Safety and feasibility of the prostatic urethral lift: a novel, minimally invasive treatment for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH)
.
BJU Int
.
2011
;
108
(
1
):
82
. .
48.
McNicholas
TA
,
Woo
HH
,
Chin
PT
,
Bolton
D
,
Fernández Arjona
M
,
Sievert
KD
,
Minimally invasive prostatic urethral lift: Surgical technique and multinational experience
.
Eur Urol
.
2013
;
64
(
2
):
292
. .
49.
Woo
HH
,
Bolton
DM
,
Laborde
E
,
Jack
G
,
Chin
PT
,
Rashid
P
,
Thavaseelan
J
,
Preservation of sexual function with the prostatic urethral lift: a novel treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia
.
J Sex Med
.
2012 Feb
;
9
(
2
):
568
75
.
50.
Barkin
J
,
Giddens
J
,
Incze
P
,
Casey
R
,
Richardson
S
,
Gange
S
.
UroLift system for relief of prostate obstruction under local anesthesia
.
Can J Urol
.
2012
;
19
(
2
):
6217
.
51.
Gratzke
C
,
Barber
N
,
Speakman
MJ
,
Berges
R
,
Wetterauer
U
,
Greene
D
,
“Prostatic urethral lift vs. transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study.”
BJU Int
.
2017 May
;
119
(
5
):
767
75
. .
52.
Dixon
C
,
Cedano
ER
,
Pacik
D
,
Vit
V
,
Varga
G
,
Wagrell
L
,
Efficacy and safety of Rezūm system water vapor treatment for lower urinary tract symptoms secondary to benign prostatic hyperplasia
.
Urology
.
2015
;
86
(
5
):
1042
. .
53.
Dixon
CM
,
Cedano
ER
,
Pacik
D
,
Vit
V
,
Varga
G
,
Wagrell
L
,
Two-year results after convective radiofrequency water vapor thermal therapy of symptomatic benign prostatic hyperplasia
.
Res Rep Urol
.
2016
;
8
:
207
. .
54.
McVary
KT
,
Gange
SN
,
Gittelman
MC
,
Goldberg
KA
,
Patel
K
,
Shore
ND
,
Minimally invasive prostate convective water vapor energy ablation: a multicenter, randomized, controlled study for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia
.
J Urol
.
2016 May
;
195
(
5
):
1529
38
.
55.
Roehrborn
CG
,
Gange
SN
,
Gittelman
MC
,
Goldberg
KA
,
Patel
K
,
Shore
ND
,
Convective thermal therapy: durable 2-year results of randomized controlled and prospective crossover studies for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia
.
J Urol
.
2017
;
197
(
6
):
1507
. .
56.
McVary
KT
,
Roehrborn
CG
.
Three-year outcomes of the prospective, randomized controlled Rezūm system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia
.
Urology
.
2018 Jan
;
111
:
1
9
.
57.
McVary
KT
,
Rogers
T
,
Roehrborn
CG
.
Rezūm water vapor thermal therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia: 4-year results from randomized Controlled Study
.
Urology
.
2019 Apr
;
126
:
171
9
.
58.
Mollengarden
D
,
Goldberg
K
,
Wong
D
,
Roehrborn
C
.
Convective radiofrequency water vapor thermal therapy for benign prostatic hyperplasia: a single office experience
.
Prostate Cancer Prostatic Dis
.
2018 Sep
;
21
(3):
379
85
.
59.
Darson
MF
,
Alexander
EE
,
Schiffman
ZJ
,
Lewitton
M
,
Light
RA
,
Sutton
MA
,
Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezūm system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia
.
Res Rep Urol
.
2017
;
9
:
159
. .
60.
Gupta
N
,
Holland
B
,
Dynda
D
,
Köhler
T
,
McVary
K
.
PD27-02 comparison of convective radiofrequency water vapor energy ablation of proSTATE (REZUM®) to MTOPS trial cohort
.
J Urol
.
2017
;
197
(
4S
):
e511
.
61.
McVary
KT
,
Rogers
T
,
Mahon
J
,
Gupta
NK
.
Is sexual function better preserved after water vapor thermal therapy or medical therapy for lower urinary tract symptoms due to benign prostatic hyperplasia?
J Sex Med
.
2018 Dec
;
15
(
12
):
1728
38
.
62.
Gupta
N
,
Rogers
T
,
Holland
B
,
Helo
S
,
Dynda
D
,
McVary
KT
.
Three-year treatment outcomes of water vapor thermal therapy compared to doxazosin, finasteride and combination drug therapy in men with benign prostatic hyperplasia: cohort data from the MTOPS trial
.
J Urol
.
2018 Aug
;
200
(
2
):
405
13
.
63.
McVary
KT
,
Holland
B
,
Beahrs
JR
.
Water vapor thermal therapy to alleviate catheter-dependent urinary retention secondary to benign prostatic hyperplasia
.
Prostate Cancer Prostatic Dis
.
2019 Jun
;
23
(
2
):
303
8
.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.