[Minimally Invasive Treatment of Benign Prostate Enlargement]

Minimally Invasive Treatment of Benign Prostate Enlargement Abstract: Minimally invasive techniques are becoming increasingly important treatment options for benign prostate enlargement. With regard to the available evidence, UroLift has a high level of evidence with two prospective randomized studies compared to sham surgery or TUR-P (Transurethral resection of the prostate). The technique is characterized by a significantly higher rate of ejaculation preservation compared to TUR-P, while the improvement in objective voiding parameters is inferior to TUR-P. With regard to Rezum water vapor ablation of the prostate, data from a randomized study compared to sham surgery and several cohort studies are available, which show a significant improvement in urinary symptoms with a high rate of sexual function preservation. The iTIND (temporary implantable nitinol device) procedure has the least amount of evidence, with only one randomized study versus sham surgery with a follow-up of one year. This technique also shows a significant improvement in urinary symptoms with a low rate of comorbidities. Prostatic stents have been on the market for many years, but data from randomized trials are still lacking. When selecting minimally invasive techniques, one should balance the wishes and expectations of the patient with respect to less comorbidities and impact on sexual function against potentially inferior improvement of symptoms and micturition parameters compared to standard techniques.