Abstract
Introduction
Benign prostatic hyperplasia (BPH) is one of the most common diseases affecting men and can present with bothersome lower urinary tract symptoms (LUTS). Historically, transurethral resection of the prostate (TURP) has been considered the gold standard in the treatment of LUTS due to BPH. However, TURP and other traditional options for the surgical management of LUTS secondary to BPH are associated with high rates of sexual dysfunction. In the past decade, several novel technologies, including Aquablation therapy, convective water vapor therapy (Rezum), and transperineal prostate laser ablation (TPLA), have demonstrated promising evidence to be safe and effective while preserving sexual function.
Methods
In this review, we discuss three ablative minimally invasive surgeries: Aquablation, Rezum, and TPLA. We review their techniques, safety, as well as perioperative and functional outcomes. We go into further detail regarding sexual function after these ablative minimally invasive surgical therapies.
Results
Aquablation is a surgeon-guided, robot-executed, heat-free ablative waterjet procedure with sustained functional outcomes at 5 years while having no effect on sexual activity. Rezum is an innovative office-based, minimally invasive surgical option for BPH that delivers convective water vapor energy into prostate adenoma to ablate obstructing tissue. Rezum leads to significant improvements in Qmax, IPSS while preserving sexual function. TPLA is another office-based technology which uses a diode laser source to produce thermoablation. It leads to improvement in Qmax, IPSS, and QoL while preserving ejaculatory function.
Conclusions
Overall, ablative minimally invasive surgical therapies have demonstrated excellent safety and efficacy profiles while preserving sexual function. These modalities should be discussed with patients to ensure informed and shared decision-making. Ablative minimally invasive surgical therapies may be particularly interesting to patients who value the preservation of their sexual function.
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DDN: Project development, Data collection, Manuscript writing. TL: Project development, Data collection, Manuscript writing. RF: Data collection, Manuscript writing. MBB: Manuscript writing. AVN: Manuscript writing. BC: Project development, Manuscript editing, Supervision. KCZ: Project development, Manuscript editing, Supervision. NB: Project development, Manuscript editing, Supervision. DE: Project development, Manuscript editing, Supervision.
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Dr. Elterman is a consultant/investigator for Boston Scientific, Procept Biorobotics, Olympus, Urotronic, Prodeon, and Zenflow. Dr. Chughtai is a consultant for Boston Scientific, Olympus, Procept, and Prodeon. Dr. Zorn is a consultant/investigator for Boston Scientific and Procept BioRobotics. Dr. Bhojani is a consultant/investigator for Boston Scientific, Procept BioRobotics, and Olympus. All other authors report no relevant competing interests.
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Nguyen, DD., Li, T., Ferreira, R. et al. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis 27, 22–28 (2024). https://doi.org/10.1038/s41391-023-00669-z
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DOI: https://doi.org/10.1038/s41391-023-00669-z
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