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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 June 2026 | Viewed by 917

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Department of Urology & Andrology, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria
Interests: non-muscle invasive bladder cancer; muscle invasive bladder cancer; robotic surgery
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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 (1 paper)

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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 599
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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