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Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation

Prostate Cancer and Prostatic Diseases volume 27, pages 22–28 (2024)Cite this article

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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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Author information

Author notes

  1. These authors contributed equally: David-Dan Nguyen, Tiange Li.

Authors and Affiliations

  1. Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada

    David-Dan Nguyen, Tiange Li, Mohamad Baker Berjaoui & Dean Elterman

  2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada

    Roseanne Ferreira

  3. Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Anna-Lisa V. Nguyen

  4. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Bilal Chughtai

  5. Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, Canada

    Kevin C. Zorn & Naeem Bhojani

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  1. David-Dan Nguyen
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Contributions

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.

Corresponding author

Correspondence to Dean Elterman.

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Competing interests

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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