Abstract. Benign prostatic hyperplasia (BPH) is a common disease among men, especially older men, presenting with symptoms of lower urinary tract (LUTR). Modern minimally invasive surgical treatments, such as transurethral resection of the prostate (TURP), prostatic artery embolization (PAE), holmium laser enucleation of the prostate (HoLEP), aquablation, temporary implantable nitinol device (iTind), and transurethral microwave thermotherapy (TUMT), offer effective alternatives with less trauma compared to traditional surgery.

Keywords: benign prostatic hyperplasia, minimally invasive surgery, transurethral resection, laser enucleation, aquablation, prostatic artery embolization, lower urinary tract

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1. Awedew AF, Han H, Abbasi B, Abbasi-Kangevari M, Ahmed MB, Almidani O, et al. The global, regional, and national burden of benign prostatic hyperplasia in 204 countries and territories from 2000 to 2019: a systematic analysis for the Global Burden of Disease Study 2019.Lancet Healthy Longev. 2022;3(11):e754–e776. doi.org/10.1016/s2666-7568(22)00213-6
2. Cornu JN, Zantek P, Burtt G, Martin C, Martin A, Springate C, et al. Minimally invasive treatments for benign prostatic obstruction: a systematic review and network meta-analysis. Eur Urol. 2023;83(6):534–547. doi.org/10.1016/j.eururo.2023.02.028
3. Horovyi VI, Shaprynskyi VO, Tserkovniuk RKh, Sosnin MD, Moraru-Burlesku RP, Chaika OM, et al. Evoliutsiia prostatektomii u patsiientiv z dobroiakisnoiu hiperplaziieiu peredmikhurovoi zalozy: vid vidkrytoho do laparoskopichnykh ta robotosystovanykh tekhnik. Kharkivska Khirurhichna Shkola. 2026;(1):67–76. doi.org/10.37699/2308-7005.1.2026.10
4. Franco JVA, Jung JH, Imamura M, Borofsky M, Omar MI, Escobar Liquitay CM, et al. Minimally invasive treatments for benign prostatic hyperplasia: a Cochrane network meta-analysis. BJU Int. 2022;130(2):142-156. doi.org/10.1111/bju.15653
5. Busetto GM, Checchia A, Recchia M, Tocci E, Falagario UG, Annunziata G, et al. Minimally invasive surgical therapies (MISTs) for lower urinary tract symptoms (LUTS): promise or panacea? Asian J Androl. 2023;25(6):645–651. doi.org/10.4103/aja202357
6. Dey A, Mamoulakis C, Hasan N, Yuan Y, Shakil A, Omar MI. Emerging technologies for the surgical management of lower urinary tract symptoms secondary to benign prostatic obstruction: a systematic review. Eur Urol Focus. 2024;10(3):400–409. doi.org/10.1016/j.euf.2023.09.003
7. De Rienzo G, Lorusso A, Minafra P, Zingarelli M, Papapicco G, Lucarelli G, et al. Transperineal interstitial laser ablation of the prostate, a novel option for minimally invasive treatment of benign prostatic obstruction. Eur Urol. 2021;80(1):95–103. doi.org/10.1016/j.eururo.2021.02.034
8. Destefanis P, Sibona M, Vitiello F, Vercelli E, Micai L, Montefusco G, et al. Trans-perineal laser ablation of the prostate in high surgical risk patients affected by severe lower urinary tract symptoms related to benign prostatic obstruction. Prostate Cancer Prostatic Dis. 2023;26(4):744–749.doi.org/10.1038/s41391-023-00736-5
9. Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ. 2018;361:k2338. doi.org/10.1136/bmj.k2338
10. Abt D, Müllhaupt G, Hechelhammer L, Markart S, Güsewell S, Schmid HP, et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic hyperplasia: 2-year outcomes of a randomised, open-label, single-centre trial. Eur Urol. 2021;80(1):34–42.doi.org/10.1016/j.eururo.2021.02.008
11. Jiang Y, Bai X, Zhang X, Wang M, Tian J, Mu L, et al. Comparative study of the effectiveness and safety of transurethral bipolar plasmakinetic enucleation of the prostate and transurethral bipolar plasmakinetic resection of the prostate for massive benign prostate hyperplasia (> 80 mL). Med Sci Monit. 2020;26:e921272. doi.org/10.12659/MSM.921272
12. Zhang J, Wang Y, Li S, Jin S, Zhang S, Zhao C, et al. Efficacy and safety evaluation of transurethral resection of the prostate versus plasmakinetic enucleation of the prostate in the treatment of massive benign prostatic hyperplasia. Urol Int. 2021;105(9-10):735–742. doi.org/10.1159/000511116
13. Busetto GM, Lombardo R, De Nunzio C, Tema G, De Luca M, Tubaro A. Ejaculation sparing of classic and minimally invasive surgical treatments of LUTS/BPH. Prostate Cancer Prostatic Dis. 2024;27(3):441–448. doi.org/10.1038/s41391-024-00834-y
14. Lambertini L, Sandulli A, Coco S, Paganelli D, Cadenar A, Dell'Oglio P, et al. Complication rate across the minimally invasive surgical treatments (MISTs): where do we stand? A systematic review of the literature. Prostate Cancer Prostatic Dis. 2025;28(3):639–651. doi.org/10.1038/s41391-024-00900-5
15. Elshazly M, Sultan S, Shaban M, Zanaty F. Evaluation of a novel technique of bladder neck and supramontanal sparing ejaculatory preserving transurethral prostatectomy. World J Urol. 2021;39(11):4215–4219. doi.org/10.1007/s00345-021-03752-z
16. Manasa T, Reddy N, Puvvada S, Mylarappa P. Evaluating outcomes of combined bladder neck and supramontanal sparing ejaculatory preserving transurethral resection of the prostate: results from a prospective, randomised study. Cent European J Urol. 2022;75(3):292–298. doi.org/10.5173/ceju.2022.0004
17. Mylarappa YP, Thimmegowda M, Mylarappa P. MP20-09 Evaluating outcomes of combined bladder neck and supramontanal sparing ejaculatory preserving TURP: results from a prospective, randomised study. J Urol. 2024;211(5 Suppl):e323.doi.org/10.1097/01.JU.0001008732.80104.31.09
18. Müllhaupt G, Hechelhammer L, Graf N, Mordasini L, Schmid HP, Engeler DS, et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic obstruction: 5-year outcomes of a randomised, open-label, noninferiority trial. Eur Urol Focus.2024;10(3):474–480.doi.org/10.1016/j.euf.2024.03.001
19. Jung JH, McCutcheon KA, Borofsky M, Young S, Golzarian J, Reddy B, et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2020;12(12):CD012867. doi.org/10.1002/14651858.CD012867.pub2
20. Ini’ C, Vasile T, Foti PV, Timpanaro C, Castiglione DG, Libra F, et al. Prostate artery embolization as minimally invasive treatment for benign prostatic hyperplasia: an updated systematic review. J Clin Med. 2024;13(9):2530. doi.org/10.3390/jcm13092530
21. Franco A, Ditonno F, Manfredi C, Bologna E, Licari LC, Orecchia L, et al. Systematic review and pooled analysis of functional and sexual outcomes of minimally invasive surgical treatments for benign prostatic obstruction. Eur Urol. 2026;89(4):318–331. doi.org/10.1016/j.eururo.2025.09.004
22. Ray AF, Powell J, Speakman MJ, Longford NT, DasGupta R, Bryant T, et al. Efficacy and safety of prostate artery embolization for benign prostatic hyperplasia: an observationalstudy and propensity-matched comparison with transurethral resection of the prostate (the UK-ROPE study). BJU Int. 2018;122(2):270–282. doi.org/10.1111/bju.14249
23. Bhatia A, Porto JG, Titus RS, Daher JC, Zavos TM, Lopategui DM, et al. Evaluating the efficacy and safety of Holmium laser enucleation of the prostate in patients with obstructive uropathy attributable to bladder outlet obstruction. World J Urol. 2024;42(1):572.doi.org/10.1007/s00345-024-05278-6
24. Tricard T, Xia S, Xiao D, Tong Z, Gaillard V, Sun J. Outcomes of holmium laser enucleation of the prostate (HoLEP) for very large-sized benign prostatic hyperplasia (over 150 mL): open simple prostatectomy is dead. World J Urol. 2023;41(8):2249–2253. doi.org/10.1007/s00345-023-04486-w
25. Grosso AA, Amparore D, Di Maida F, de Cillis S, Cocci A, Di Dio M, et al. Comparison of perioperative and short-term outcomes of en-bloc Holmium laser enucleation of the prostate (HoLEP) and robot-assisted simple prostatectomy: a propensity-score matching analysis. Prostate Cancer Prostatic Dis. 2023;26(4):739–743. doi.org/10.1038/s41391-023-00743-6
26. Porreca A, Colicchia M, Tafuri A, D'Agostino D, Busetto GM, Crestani A, et al. Perioperative outcomes of Holmium laser enucleation of the prostate: a systematic review. Urol Int. 2022;106(10):979–991. doi.org/10.1159/000524364
27. Migliari R, Mele F, Barale M, De Rosa G, Migliari M, Giacobbe A. An innovative technique for ejaculation-sparing prostatic enucleation with Thulium:YAG laser. J Endourol. 2023;37(12):1282–1288.doi.org/10.1089/end.2023.0277
28. Sotimehin AE, Haile E, Gill BC. Contemporary surgical and procedural management of benign prostatic hyperplasia. Cleve Clin J Med. 2023;90(12):745–753. doi.org/10.3949/ccjm.90a.23026
29. Siqueira MHB, Berjaoui MB, Bhojani N, Te A, Gilling P, Badlani G, et al. Outcomes of aquablation: pooled analysis from the WATER, WATER II, OPEN WATER, FRANCAIS WATER, and JAPAN PMS studies. World J Urol. 2025;43(1):635. doi.org/10.1007/s00345-025-06033-1
30. Bhojani N, Bidair M, Kramolowsky E, Desai M, Doumanian L, Zorn KC, et al. Aquablation therapy in large prostates (80-150 mL) for lower urinary tract symptoms due to benign prostatic hyperplasia: final WATER II 5-year clinical trial results. J Urol. 2023;210(1):143–153.doi.org/10.1097/JU.0000000000003490
31. Gilling PJ, Barber N, Bidair M, Anderson P, Sutton M, Aho T, et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. Can J Urol. 2022;29(1):10960–10968.
32. Raizenne BL, Bouhadana D, Zorn KC, Barber N, Gilling P, Kaplan S, et al. Functional and surgical outcomes of Aquablation in elderly men. World J Urol. 2022;40(10):2515–2520.doi.org/10.1007/s00345-022-04136-7
33. Hwang EC, Jung JH, Borofsky M, Kim MH, Dahm P. Aquablation of the prostate for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2019;2(2):CD013143. doi.org/10.1002/14651858.CD013143.pub2
34. Misrai V, Rijo E, Zorn KC, Barry-Delongchamps N, Descazeaud A. Waterjet ablation therapy for treating benign prostatic obstruction in patients with small- to medium-size glands: 12-month results of the first French Aquablation clinical registry. Eur Urol. 2019;76(5):667–675.doi.org/10.1016/j.eururo.2019.06.024
35. Nguyen DD, Li T, Ferreira R, Baker Berjaoui M, Nguyen ALV, Chughtai B, 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. 2024;27(1):22–28.doi.org/10.1038/s41391-023-00669-z
36. Bragion CB, Cordeiro MD, de Faria SM. Modified robotic simple prostatectomy technique: a retrospective analysis of a series of 162 surgeries performed by a high-volume surgeon.J Robot Surg. 2024;18(1):373. doi.org/10.1007/s11701-024-02129-9
37. Di Gianfrancesco L, D'Agostino D, Marino F, De Marchi D, Giampaoli M, Amodeo A, et al. The core aquablation pentafecta: a five-domain composite definition of procedural success and learning curve validation in 300 consecutive cases. J Robot Surg. 2026;20(1):290. doi.org/10.1007/s11701-026-03250-7
38. Annese P, d'Altilia N, Mancini V, Falagario UG, Del Giudice F, Ferro M, et al. Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center. Ther Adv Urol. 2021;13:17562872211037109.doi.org/10.1177/17562872211037109
39. Bilhim T, Betschart P, Lyatoshinsky P, Müllhaupt G, Abt D. Minimally invasive therapies for benign prostatic obstruction: a review of currently available techniques including prostatic artery embolization, water vapor thermal therapy, prostatic urethral lift, temporary implantable nitinol device and aquablation. Cardiovasc Intervent Radiol. 2022;45(4):415–24.doi.org/10.1007/s00270-021-03052-4
40. Jung JH, Reddy B, McCutcheon KA, Borofsky M, Narayan V, Kim MH, et al. Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2019;5(5):CD012832. doi.org/10.1002/14651858.CD012832.pub2
41. Passarelli F, Castellani D, Secco S, Gacci M, Sibona M, Goumas IK, et al. Minimally invasive surgical techniques (MISTs) for benign prostatic hyperplasia: results from a Delphiconsensus project to shed light on controversial topics. World J Urol. 2025;43(1):363.doi.org/10.1007/s00345-025-05727-w
42. Kim JH, Lee KS, Kim TH. Evaluation of clinical outcomes of prostatic urethral lift for benign prostatic hyperplasia: an Asian population study. World J Mens Health. 2020;38(3):338–344. doi.org/10.5534/wjmh.190042
43. Wroclawski ML, Takemura LS, Santos HOD, Heldwein FL, Gauhar V, Lim EJ, et al. Functional and safety outcomes after benign prostatic enlargement surgeries in men with detrusor underactivity compared with normal detrusor contractility: systematic review and meta-analysis. Neurourol Urodyn. 2024;43(1):126–143. doi.org/10.1002/nau.25336
44. Amparore D, Fiori C, Valerio M, Schulman C, Giannakis I, De Cillis S, et al. 3-year results following treatment with the second generation of the temporary implantable nitinol device in men with LUTS secondary to benign prostatic obstruction. Prostate Cancer Prostatic Dis. 2021;24(2):349–357. doi.org/10.1038/s41391-020-00281-6
45. De Nunzio C, Cantiello F, Fiori C, Crocerossa F, Tognoni P, Amparore D, et al. Urinary and sexual function after treatment with temporary implantable nitinol device (iTind) in men with LUTS: 6-month interim results of the MT-06-study. World J Urol. 2021;39(6):2037–2042.doi.org/10.1007/s00345-020-03424-4
46. Elterman D, Alshak MN, Martinez Diaz S, Shore N, Gittleman M, Motola J, et al. An evaluation of sexual function in the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia in men treated with the temporarily implanted nitinol device. J Endourol. 2023;37(1):74–79. doi.org/10.1089/end.2022.0415
47. Olivero A, De Cillis S, Amparore D, Giudici S, Buratto C, Cellini V, et al. Twenty-four months failure rate and functional outcomes comparison after implantable nitinol device (iTIND) and prostatic urethral lift (Urolift): real world multicenter study. Urologia. 2026;93(2):200–205.doi.org/10.1177/03915603251406809
48. Kadner G, Valerio M, Giannakis I, Manit A, Lumen N, Ho BSH, et al. Second generation of temporary implantable nitinol device (iTind) in men with LUTS: 2 year results of the MT-02-study. World J Urol. 2020;38(12):3235–3244.doi.org/10.1007/s00345-020-03137-8
49. Porpiglia F, Fiori C, Amparore D, Kadner G, Manit A, Valerio M, et al. Second-generation of temporary implantable nitinol device for the relief of lower urinary tract symptoms due to benign prostatic hyperplasia: results of a prospective, multicentre study at 1 year of follow-up. BJU Int. 2019;123(6):1061–1069. doi.org/10.1111/bju.14608
50. Franco JV, Garemalli L, Escobar Liquitay CM, Borofsky M, Dahm P. Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2021;6(6):CD004135.doi.org/10.1002/14651858.CD004135.pub4
51. Kristensen-Alvarez A, Fode M, Stroomberg HV, Nielsen KK, Arch A, Lönn LB, et al. Non-inferiority, randomised, open-label clinical trial on the effectiveness of transurethral microwave thermotherapy compared to prostatic artery embolisation in reducing severe lower urinary tract symptoms in men with benign prostatic hyperplasia: study protocol for the TUMT-PAE-1 trial. Trials. 2024;25(1):574.doi.org/10.1186/s13063-024-08409-x
52. Tafuri A, Panunzio A, De Carlo F, Luperto E, Di Cosmo F, Cavaliere A, et al. Transperineal laser ablation for benign prostatic enlargement: a systematic review and pooled analysis of pilot studies. J Clin Med. 2023;12(5):1860.doi.org/10.3390/jcm12051860
53. Bertolo R, Iacovelli V, Cipriani C, Carilli M, Vittori M, Antonucci M, et al. Ejaculatory function following transperineal laser ablation vs TURP for benign prostatic obstruction: a randomized trial. BJU Int. 2023;132(1):100–108.doi.org/10.1111/bju.16008
54. Pacella CM, Patelli G, Iapicca G, Manenti G, Perretta T, Ryan CP, et al. Transperineal laser ablation for percutaneous treatment of benign prostatic hyperplasia: a feasibility study. Results at 6 and 12 months from a retrospective multi-centric study. Prostate Cancer Prostatic Dis. 2020;23(2):356–363. doi.org/10.1038/s41391-019-0190-6
55. Chung ASJ, Woo HH. Update on minimally invasive surgery and benign prostatic hyperplasia. Asian J Urol. 2018;5(1):22–27. doi.org/10.1016/j.ajur.2017.06.001
56. Chiu P, Siu B, De Nunzio C. Selecting Minimally Invasive Surgical Treatments for Benign Prostatic Hyperplasia: A Clinical Consultation Guide. European Urology Focus, 2025;11, 553–556.doi.org/10.1016/j.euf.2025.04.025
57. Malde S, Umbach R, Wheeler JR, Lytvyn L, Cornu JN, Gacci M, et al. A systematic review of patients' values, preferences, and expectations for the diagnosis and treatment of male lower urinary tract symptoms. Eur Urol. 2021;79(6):796–809. doi.org/10.1016/j.eururo.2021.01.013
58. Cahill EM, Lindenbaum MM, Estright A, Ljubetic BM, Aslot V, Nero N, et al. The impact of minimally invasive surgical therapy for benign prostatic hyperplasia on sexual function: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2026. https://www.nature.com/articles/s41391-026-01091-x
59. Ng BHS, Chung E. A state-of-the-art review on the preservation of sexual function among various minimally invasive surgical treatments for benign prostatic hyperplasia: impact on erectile and ejaculatory domains. Investig Clin Urol. 2021;62(2):148–158.doi.org/10.4111/icu.20200392
60. Pace KJC, Li T, Elterman DS. Next-gen minimally invasive surgical therapies for benign prostatic hyperplasia: innovations, selection, and best practices. Curr Opin Urol. 2026;36(1):51–56.doi.org/10.1097/MOU.0000000000001335
61. Chen D, Qu L, Webb H, Qin K, Chislett B, Xue A, et al. Aquablation in men with benign prostate hyperplasia: a systematic review and meta-analysis. Curr Urol. 2023;17(2):68–76.doi.org/10.1097/cu9.0000000000000122
62. Long Depaquit T, Reus R, Uleri A, Bastide C, Berchiche W, Peyrottes A, et al. Comparative analysis of functional and economic outcomes of prostatic urethral lift and water vapor thermal therapy for male LUTS: a French perspective. Fr J Urol. 2025;35(5):102872. doi.org/10.1016/j.fjurol.2025.102872
63. Grossmann NC, Berjaoui MB, Choudhary O, Pradere B, Somani BK, Elterman DS.State-of-the-art in minimally invasive treatments for benign prostatic obstruction. Investig Clin Urol. 2026;67(1):1–14.doi.org/10.4111/icu.20250390
64. Abid A, Piperdi H, Babar M, Loloi J, Moutwakil A, Azhar U, et al. Minimally invasive surgical therapies for benign prostatic hyperplasia in the geriatric population: a systematic review. Prostate. 2024;84(10):895–908. doi.org/10.1002/pros.24717
65. Bilhim T, Betschart P, Lyatoshinsky P, Müllhaupt G, Abt D. Minimally invasive therapies for benign prostatic obstruction: a review of currently available techniques including prostatic artery embolization, water vapor thermal therapy, prostatic urethral lift, temporary implantable nitinol device and aquablation. Cardiovasc Intervent Radiol. 2022;45(4):415–424.doi.org/10.1007/s00270-021-03052-4
66. Zhang X, Liang T, Dong Y, Gao H. Minimally invasive treatments for benign prostatic hyperplasia: a narrative review. Medicine (Baltimore). 2026;105(12):e47951. doi.org/10.1097/MD.0000000000047951
67. Klein C, Anract J, Pinar U, Chevrot A, Della Negra E, Fassi-Fehri H, et al. Surgical and interventional management of bladder outlet obstruction related to benign prostatic hyperplasia: systematic review of the literature and clinical practice guidelines from the French Male LUTS Committee (CTMH). Fr J Urol. 2025;35(11):102951. doi.org/10.1016/j.fjurol.2025.102951