Minimally invasive surgical therapies for benign prostatic hyperplasia have low retreatment rates

Advancements in minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia (BPH) provide durable benefit and may limit the need for retreatment, according to a systematic review of more than 50 studies presented at the 2025 Annual Meeting of the American Urological Association in Las Vegas, Nevada.

While transurethral resection of the prostate has long represented the gold standard of treatment for BPH, the past decade has witnessed a steep rise in the uptake of novel surgical treatments. Minimally invasive therapies have been shown to achieve similar functional outcomes with a lower risk for complications, including sexual dysfunction. Studies have generally documented low retreatment rates after MISTs for BPH [Kaplan S et al. Prostate Cancer Prostatic Dis. 27, 485–491 (2024)]. However, the need for retreatment can vary considerably across different therapies. 
Researchers in the department of urology at Trakya University, in Edirne, Turkey conducted a systematic review of studies included in Medline, Embase, and the Cochrane Library through October 2024 to evaluate and compare the retreatment rates for various MISTs. Fifty-seven studies that addressed retreatment rates after undergoing MISTs for BPH were eventually selected for inclusion. The review included randomized controlled trials and observational studies that assessed treatment failure and retreatment rates associated with different MISTs, including prostatic urethral lift (PUL/Urolift), Aquablation, water vapor thermal therapy (Rezūm), temporarily implantable nitinol device (iTIND), Optilume BPH catheter system, prostatic artery embolization (PAE), transurethral needle ablation (TUNA), and transurethral microwave thermotherapy (TUMT).

The analysis showed that Optilume, Aquablation, and Rezūm were associated with the lowest retreatment rates. Optilume and Aquablation required no retreatment in the first year. Optilume had overall retreatment rates of 1.25% at 2 years and 1.3% through 4 years, while Aquablation was associated with retreatment rates of 4.4% to 6% by the 5-year mark. Rezūm had a 1.6% retreatment rate at 1 year, which increased to 8% by the second year but dropped to 4.4% in studies with a 5-year follow-up. Other minimally invasive therapies, however, showed higher retreatment rates. The increase in retreatment need seemed to be related to key factors such as the age of patients and the use of antithrombotic therapy. 

“MISTs provide effective symptom relief for BPH patients, with varying retreatment rates across modalities,” the authors concluded. “While certain MISTs exhibit lower retreatment rates, treatment choice should consider patient specific factors, likelihood of retreatment, and cost-effectiveness. Future research is needed to optimize patient selection and evaluate long-term outcomes for MISTs in BPH management.”