Minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia: Initial single-center experience

Minimally invasive surgical therapies (MIST) have emerged as effective alternatives to transurethral resection of the prostate for the management of benign prostatic hyperplasia (BPH), offering symptomatic relief with reduced morbidity and preservation of sexual function. However, real-world data, particularly from Indian centers, remain limited.

This prospective observational study included 20 patients with symptomatic BPH undergoing MIST, comprising Rezūm (n = 14), prostatic urethral lift (UroLift; n = 3), and temporary implantable nitinol device (iTIND; n = 3). Patients with moderate-to-severe lower urinary tract symptoms (LUTS) or catheter-dependent urinary retention were included. Outcomes assessed at 1, 3, and 6 months included International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), erectile function (IIEF-5), catheter status, and complications.

The mean age was 66.2 years, and mean prostate volume was 43 g. Ten patients (50%) presented with catheter-dependent urinary retention. Mean IPSS improved from 22.9 preoperatively to 11.2 at 6 months, while mean Qmax increased from 9.1 mL/s to 16.3 mL/s. Among catheter-dependent patients, 9/10 (90%) achieved successful trial without catheter. Erectile function remained stable in patients undergoing UroLift and iTIND procedures. One patient (5%) required secondary intervention (TURP) due to failed Rezūm therapy. No major complications were observed.

MIST procedures, including Rezūm, UroLift, and iTIND, provide significant improvement in urinary symptoms and flow with excellent safety and preservation of sexual function. These therapies are effective even in selected patients with urinary retention and represent viable alternatives to conventional surgery.