Minimally invasive treatments for benign prostatic hyperplasia

Minimally invasive treatment (MIT) options for relief of symptoms attributed to benign prostatic obstruction (BPO) are becoming a more commonly used option for patients failing medical therapy. These MIT utilize an endoscopic approach to either ablate the obstructing prostatic tissue by a variety of techniques or to place a urethral stent to relieve BPO. The uniting factor in all MIT is to decrease or eliminate the current morbidity and complications that accompany the standard surgical therapy such as transurethral resection of prostate (TURP). Clinical trials evaluating the efficacy and morbidity of these MIT modalities, either alone or in comparison to TURP are reviewed. Level I evidence (randomized controlled trials) are present for most of the MITs and provide the strongest support for overall conclusions. Symptomatic improvements and quality of life (QoL) improvements for all of the MIT follow a similar pattern with a more pronounced improvement in outcomes for the more ablative techniques. Uroflowmetry and durability of outcomes, however, seem to demonstrate little differences amongst the therapies. Disparities existed in the morbidity observed with the different techniques. Urinary retention and urinary infections were more common in the ablative technologies. Rates of blood loss, urinary incontinence, sexual dysfunction and urethral strictures were observed at a lower rate in the MIT groups when compared to the rates observed in TURP. The morbidity and durability of TURP is higher and longer than that of MIT, respectively.