Novel Surgical Treatments for Benign Prostatic Hyperplasia

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Blessing Dhliwayo
Saheel Mukhtar, SM


Aquablation, Prostate artery embolization, Prostatic Urethral Lift, Water Vapour thermal therapy, Rezūm


Transurethral resection of the prostate (TURP) has been the gold standard for the treatment of elderly men with lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH). However, over the last few years, advances in surgical treatment have led to the development of other treatment modalities. These innovations include convective WAter Vapor Energy (WAVE; Rezum System), prostatic urethral lift (PUL; UroLift System), Prostate Artery Embolisation (PAE) and Aquablation (AQUABEAM System). This review provides an update on these current minimal invasive surgical treatments. The evidence of their safety, tolerability and efficacy in clinical practice is reviewed.

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1. Dixon C, Cedano ER, Pacik D, et al. PD26-09 transurethral water vapor therapy for BPH. 1-year clinical results of the first in man and Rezum I clinical trials using the Rezum system. J Urol 2014:4(191):e762.
2. Mynderse LA, Hanson D, Robb RA et al. Rezum system water vapor treatment for LUTS / BPH: validation of convective thermal energy transfer and characterization with magnetic resonance imaging and 3-dimensional renderings, Urology 2015:86(1):122–27.
3. Dixon C, RijoCedano E, Pacik D, et al. Efficacy and safety of Rezum system water vapor treatment for lower urinary tract symptoms secondary to BPH. Urology 2015;86(5):1042–47
4. McVary KT, Roehrborn CG. Three-year outcomes of the prospective, randomized controlled Rezum system study: convective radiofrequency thermal therapy for treatment of lower urinary tract symptoms due to BPH. Urology 2018 Jan;111:1–9. doi: 10.1016/j.urology.2017.10.023. Epub 2017 Nov 6.
5. NICE guidelines on UroLift for treating lower urinary tract symptoms of BPH. Medical Technologies Guidance. [Internet] Available at:
6. Rukstalis DB. Prostatic urethral lift: a novel approach for managing symptomatic BPH in the aging man. Can J Urol 2015;22(Suppl. 1):67–74.
7. McNicholas TA. BPH and new treatment options — a critical appraisal of the UroLift system. Med Devices 2016;(Auckl)9:115–23.
8. Roehrborn CG, Rukstalis DB, Barkin J, et al. Three-year results of the prostatic urethral L.I.F.T. study Can J Urol 2015;22:7772–82.
9. Perera M, Roberts MJ, Doi SA, Bolton D. Prostatic urethral lift improves urinary symptoms and flow while preserving sexual function for men with BPH: a systematic review and meta-analysis Eur Urol 2015;67:704–13.
10. Sonksen J, Barber NJ, Speakman MJ, et al. Prospective, randomized, multinational study of prostatic urethral lift versus transurethral resection of the prostate: 12-month results from the BPH6 Study Eur Urol 2015;68:643–52.
11. DeMeritt JS, Elmasri FF, Esposito MP, Rosenberg GS. Relief of BPH related bladder outlet obstruction after transarterial polyvinyl alcohol prostate embolization. J Vasc Interv Radiol 2000 Jun;11(6):767–70.
12. Pisco JM, Bilhim T, Pinheiro LC, et al. Medium- and long-term outcome of prostate artery embolization for patients with BPH: results in 630 patients. J Vasc Interv Radiol 2016;Aug;27(8):1115–22.
13. Gao YA, Huang Y, Zhang R, et al. BPH: prostatic arterial embolization versus transurethral resection of the prostate--a prospective, randomized, and controlled clinical trial. Radiology 2014;Mar;270(3):920–8.
14. Alistair RF, Powell J, and Speakman J, et al. The UK ROPE Study: efficacy and safety of prostate artery embolization for BPH. An observational study and propensity matched comparison with transurethral resection of the prostate. BJU International 2018;122:10.1111/bju.14249.
15. Faber K, de Abreu AL, Ramos P, et al. Image-guided robot-assisted prostate ablation using water jet-hydrodissection: initial study of a novel technology for BPH. J Endourol 2015;29:63–69.
16. Gilling P, Reuther R, Kahokehr A, Fraundorfer M. Aquablation – image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int 2016;117:923–29.
17. Gilling P, Barber N, Bidair M, Anderson P et al. WATER: A Double-Blind, Randomized, Controlled Trial of Aquablation® vs Transurethral Resection of the Prostate in BPH. J Urol 2018;199(5):1252–61.