Minimally invasive therapies for benign prostatic hyperplasia

A number of minimally invasive therapies have been studied in the last decade for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Most of these utilize thermal energy to ablate the prostate. Paucity of long-term efficacy, safety and re-treatment rates are, however, the main concerns of all these forms of treatment. Minimally invasive therapies can be positioned between pharmacotherapy and transurethral resection of the prostate (TURP). Studies have shown that some of these therapies stand the test of time, with low and acceptable re-treatment rates and shorter hospital stay. Therapies such as transurethral needle ablation (TUNA) and high energy transurethral microwave thermotherapy (HE-TUMT) effectively relieve symptoms with less morbidity. Laser prostatectomy is less commonly used due to the slow and difficult resection/vaporization. Minimally invasive therapies are particularly useful in those on anticoagulants, in whom anesthesia is contraindicated and younger men with an active sex life. However, these devices have not been compared with TURP in large-scale controlled trials and, therefore, will not be able to replace TURP until their long-term durability of symptom relief is known.