Abstract and Introduction
Abstract
Purpose of Review: This review aims to give a brief description of the latest minimally invasive surgical techniques (MISTs) for the treatment of benign prostatic obstruction (BPO).
Recent Findings: In recent years technological advances have made the implementation of MISTs in the armamentarium of BPO surgery possible and in many cases could replace standard procedures.
These techniques offer many advantages -short recovery time, rapid symptomatic relief, few adverse effects, lower risk of sexual/ejaculatory dysfunction, acceptable durability and most can be performed as an outpatient procedure.
Many of the newer MISTs can be performed outside the operating room under local anesthesia, hence the term office-based MIST.
Summary: A tailored BPO surgical treatment should not only take into account the prostate volume, but also many other factors including possible adverse events and the patient's expectations.
Further studies and long-term data are necessary to standardize methods for evaluating the outcomes of these new procedures and to see which will pass the test of time and end-up replacing the gold standard procedures.
Introduction
The most common urological diagnosis for men over fifty is benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms (LUTS).
Transurethral resection of the prostate (TURP) and open simple prostatectomy are still currently the most commonly used techniques around the world for surgical BPH treatment and have been the gold standard for over a century.
In the last two decades, transurethral laser prostatectomy has become a standard procedure.
Transurethral needle ablation of the prostate (TUNA) could be considered the first attempt at a minimally invasive surgical treatment for BPH in the 1990s, however, due to a high reoperation rate it is no longer recommended by the American Urological Association (AUA)/European Association of Urology (EAU) guidelines.[1,2]
Transurethral microwave therapy (TUMT) was also removed from the EAU Guidelines in 2019, although it is still recommended by the AUA guidelines.
The defining criteria of a minimally invasive surgical technique (MIST) is unclear, however in the literature there seems to be a consensus in some basic aspects they must fulfill, like a short recovery time, well-tolerated, rapid symptomatic relief, few adverse effects, lower risk of sexual/ejaculatory dysfunction, short learning curve, acceptable durability and most can be performed as an outpatient procedure.
MISTs are not intended to replace standard surgical procedures, but in some cases, they can be an alternative to them as well as to medical therapy.
Over the past 6 years newer MISTs have been introduced, and many of them can be performed outside the operating room and using only local anesthesia, hence the term office-based MIST was coined (Table 1).
Furthermore, office-based MISTs and hospital-based minimally invasive procedures are considered one in the same, when in reality they are not, because generally the latter require an operating room, spinal or general anesthesia and at least a one-day hospital stay.[3]
Curr Opin Urol. 2021;31(5):461-467. © 2021 Wolters Kluwer Health, Inc.
