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The Treatment of BPO with Minimal Invasive Approach
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The Treatment of BPO with Minimal Invasive Approach

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: 20 January 2027 | Viewed by 2029

Editor

Prof. Dr. Lukas Lusuardi

E-Mail Website
Guest Editor
Department of Urology & Andrology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
Interests: non-muscle invasive bladder cancer; muscle invasive bladder cancer; robotic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Benign prostatic obstruction (BPO) is one of the most common causes of lower urinary tract symptoms (LUTSs) in middle-aged and older men. The treatment of BPO has dramatically changed in the last four decades. From a prostate-size-driven decision with only transurethral prostate resection (TURP) and open adenomectomy as possible surgical options in the treatment of BPO, we moved to a multifactorial driven decision with several surgical options. The main two factors influencing the choice of which surgical strategy to apply in every patient nowadays are the patient and the economic aspect. The latter influences the decision by limiting the surgical options depending on the patients’ income, patients’ insurance status and the specific country health system. The factor patient influences the decision no longer only by prostatic volume but also by individual preference, associated medical conditions and LUTSs.

Over the last two decades, a wide array of different surgical techniques have become available and some of these are producing robust evidence, including the use of holmium laser enucleation of prostate (HoLEP) for larger prostates. There are also a group of minimally invasive surgical treatment (MIST) options for BPO, which are often associated with faster post-operative recovery, day surgery suitability and lower risk of sexual dysfunction. The present Special Issue focuses on different novel minimal invasive approaches in the treatment of BPO.

Prof. Dr. Lukas Lusuardi
Guest Editor

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Keywords

  • benign prostatic obstruction (BPO)
  • prostatectomy
  • non-muscle invasive bladder cancer
  • muscle invasive bladder cancer
  • robotic surgery

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Published Papers (2 papers)

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33 pages, 1176 KB  
Systematic Review
Robot-Assisted Simple Prostatectomy Versus Endoscopic Enucleation for Large-Volume Benign Prostatic Hyperplasia: A Systematic Review and Meta-Analysis of Perioperative Outcomes and Complications
by Sophia Tsokkou, Manuela Sieberer, Ioannis Konstantinidis, David Oswald, Antonios Keramas, Christian Ramesmayer, Julia Katharina Peters, Lukas Lusuardi, Chrysovalantis Toutziaris and Petros Sountoulides
J. Clin. Med. 2026, 15(13), 5276; https://doi.org/10.3390/jcm15135276 - 6 Jul 2026
Viewed by 459
Abstract
Introduction/Background: Large-volume benign prostatic hyperplasia (≥80 mL) requires complete anatomical removal of the adenoma. Robot-assisted or minimally invasive simple prostatectomy (RASP/MISP) and anatomic endoscopic enucleation of the prostate (AEEP) have both emerged as minimally invasive alternatives to open simple prostatectomy, but their [...] Read more.
Introduction/Background: Large-volume benign prostatic hyperplasia (≥80 mL) requires complete anatomical removal of the adenoma. Robot-assisted or minimally invasive simple prostatectomy (RASP/MISP) and anatomic endoscopic enucleation of the prostate (AEEP) have both emerged as minimally invasive alternatives to open simple prostatectomy, but their comparative perioperative performance in very large glands remains incompletely defined. Objective: To systematically review and quantitatively synthesize the perioperative outcomes and complications of RASP/MISP versus AEEP in the surgical management of large-volume BPH. Methodology: Following PRISMA 2020, PubMed, Embase, Scopus and the Cochrane Library were searched from inception to 7 June 2026 for randomized and non-randomized comparative studies of RASP/MISP versus AEEP in men with mean or median prostate volume ≥ 80 mL reporting at least one perioperative or functional outcome and at least one Clavien–Dindo grade ≥ III complication. Continuous outcomes were pooled as mean differences (MD) and dichotomous outcomes as risk ratios using random-effects models (REML with Knapp–Hartung adjustment); heterogeneity was assessed with I2. Risk of bias was evaluated with the Newcastle–Ottawa Scale and ROBINS-I, and certainty of evidence with GRADE. Publication bias and leave-one-out sensitivity analyses were performed where the number of studies permitted. Results: Five comparative cohort studies published between 2017 and 2025 were included, comprising 271 patients treated with RASP/MISP and 998 treated with AEEP. AEEP was associated with a significantly shorter catheterization time (pooled MD 5.95 days; 95% CI 1.98–9.92; p = 0.014) and a shorter hospital stay (pooled MD 2.73 days; 95% CI 1.07–4.39; p = 0.010), both with high heterogeneity (I2 99.0% and 96.1%, respectively). Perioperative hemoglobin drop tended to favor AEEP without reaching significance (pooled MD 0.65 g/dL; 95% CI −0.33 to 1.63; p = 0.103), and transfusion risk was lower but not statistically significant (pooled RR ≈ 0.46; 95% CI 0.18–1.15). PSA reduction was substantial and broadly equivalent between techniques. Functional outcomes (IPSS, QoL, Qmax, PVR) improved comparably with both approaches. Leave-one-out analyses confirmed that the catheterization and length-of-stay advantages of AEEP were robust, and no evidence of publication bias was detected. Certainty of evidence was low to moderate, reflecting the observational designs. Leave-one-out analyses indicated that the catheterization and length-of-stay differences were not driven by any single study; publication bias could not be assessed reliably because fewer than ten studies contributed to any outcome. Certainty of evidence was low to moderate, reflecting the observational designs, the small number of studies, and substantial between-study heterogeneity, and the findings should be regarded as hypothesis-generating. Conclusions: In large-volume BPH, AEEP and RASP/MISP achieve comparable functional improvement and adenoma debulking, but AEEP offers superior perioperative efficiency, with markedly shorter catheterization and hospital stay and at least comparable safety. RASP/MISP remains a valuable option where robotic infrastructure is available but high-volume enucleation expertise is lacking. These findings, drawn from observational evidence of low-to-moderate certainty, support AEEP as the more resource-efficient minimally invasive option for very large glands and underline the need for randomized comparative trials. Full article
(This article belongs to the Special Issue The Treatment of BPO with Minimal Invasive Approach)
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8 pages, 543 KB  
Brief Report
Rezum: Analysis of the Tolerability and Complications of the Procedure Performed Under Local Anaesthetic
by Rowan Burns, Barend Dreyer, Sinan Khadhouri and Feras Al Jaafari
J. Clin. Med. 2026, 15(7), 2560; https://doi.org/10.3390/jcm15072560 - 27 Mar 2026
Viewed by 1092
Abstract
Background/Objectives: Rezum therapy is a novel, minimally invasive way of treating benign prostatic hyperplasia (BPH) that involves the injection of heated water vapour into the prostate. It was approved by NICE in 2018 and is now available in select centres across the UK. [...] Read more.
Background/Objectives: Rezum therapy is a novel, minimally invasive way of treating benign prostatic hyperplasia (BPH) that involves the injection of heated water vapour into the prostate. It was approved by NICE in 2018 and is now available in select centres across the UK. It has been shown to have significant advantages over standard BPH therapies: it can be done under local anaesthetic, making it an option for those unsuitable for general anaesthetic, it is suitable for treating patients who want to maintain ejaculation, and it is cost-effective. It has been recommended as a treatment for smaller prostates (<80cc) and in cases where patients are keen to preserve ejaculatory function. Our unit performs this procedure under local anaesthetic (LA) with a transperineal ultrasound-guided peri-prostatic block and urethral lidocaine gel in the clinic. We aimed to analyse the patients undergoing Rezum in our institution to establish its tolerability under local anaesthetic, its effectiveness and its complication rate. Methods: We analysed all patients who underwent Rezum prostate steam ablation in our institution between May 2023 and September 2025. From individual patient notes, we collected data on patient demographics, prostate size and shape, pre- and post-op IPSS and Qmax, and post-void residual. Patient-reported outcomes such as pain during the procedure and satisfaction of the procedure were also collected and analysed as well as complication rates. Results: The data of 82 patients undergoing LA Rezum in the above time period were collected and analysed. They had a mean prostate size of 53cc (minimum 21cc and maximum of 100cc). The results showed significant improvement in voiding parameters, with Qmax improving by 40.1% (p < 0.05) and PVR by 40.8% (p < 0.05). Patients similarly reported improved symptoms, with IPSS improving by 54.7% (p < 0.05) and QOL scores by 54.1% (p < 0.05). The procedure had a high degree of satisfaction, with 36 of the 49 patients who completed the post-procedure questionnaire recording an overall satisfaction of 9 or 10 out of 10. The mean intraoperative visual analogue (VAS) pain score was 3.5. Conclusions: Rezum is a minimally invasive procedure that has been seen to produce significant and reliable improvements in patients’ lower urinary tract symptoms and voiding dynamics. It has a low complication rate, is tolerated well and is readily performed under local anaesthetic in the ambulatory setting. Full article
(This article belongs to the Special Issue The Treatment of BPO with Minimal Invasive Approach)
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