Skip to main content
SpringerLink
Log in

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

  • Review
  • Embolisation (arterial)
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

A 66-years old male patient presents with lower urinary tract symptoms, mostly due to obstructive symptoms, and an enlarged prostate with 80 cm3, with a broad-based median lobe, suggestive of benign prostatic obstruction (BPO). Trans-urethral resection of the prostate (TURP) was proposed. However, the patient desired to preserve ejaculatory function and was afraid of a potential negative impact on erectile function. Thus, the patient inquired about minimally invasive therapies (MITs) as alternatives to TURP. In this review, currently available MITs for BPO are described including prostatic artery embolization, water vapor thermal therapy (Rezum®), prostatic urethral lift, iTIND® (temporary implantable device) and aquablation (Aquabeam®). Focus is given on the description of the technique, level of evidence and advantages over conventional surgical options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Sun F, Crisóstomo V, Báez-Díaz C, Sánchez FM. Prostatic artery embolization (PAE) for symptomatic benign prostatic hyperplasia (BPH): part 2, insights into the technical rationale. Cardiovasc Intervent Radiol. 2016;39(2):161–9.

    PubMed  Google Scholar 

  2. Martins Pisco J, Pereira J, Rio Tinto H, Fernandes L, Bilhim T. How to perform prostatic arterial embolization. Tech Vasc Interv Radiol. 2012;15(4):286–9.

    PubMed  Google Scholar 

  3. Powell T, Bhatia S, Ayyagari R. Current debates regarding optimal patient evaluation and procedural technique for prostatic artery embolization. Tech Vasc Interv Radiol. 2020;23(3):100696.

    PubMed  Google Scholar 

  4. Bilhim T, Pisco JM, Rio Tinto H, et al. Prostatic arterial supply: anatomic and imaging findings relevant for selective arterial embolization. J Vasc Interv Radiol. 2012;23(11):1403–15.

    PubMed  Google Scholar 

  5. Sun F, Lucas-Cava V, Sánchez-Margallo FM. Clinical predictive factors in prostatic artery embolization for symptomatic benign prostatic hyperplasia: a comprehensive review. Transl Androl Urol. 2020;9(4):1754–68.

    PubMed  PubMed Central  Google Scholar 

  6. Bilhim T, Pisco J, Pereira JA, et al. Predictors of clinical outcome after prostate artery embolization with spherical and nonspherical polyvinyl alcohol particles in patients with benign prostatic hyperplasia. Radiology. 2016;281(1):289–300.

    PubMed  Google Scholar 

  7. Madersbacher S, Roehrborn CG, Oelke M. The role of novel minimally invasive treatments for lower urinary tract symptoms associated with benign prostatic hyperplasia. BJU Int. 2020;126(3):317–26.

    PubMed  Google Scholar 

  8. Svarc P, Taudorf M, Nielsen MB, Stroomberg HV, Røder MA, Lönn L. Postembolization syndrome after prostatic artery embolization: a systematic review. Diagnostics (Basel). 2020;10(9):659.

    Google Scholar 

  9. Zumstein V, Binder J, Güsewell S, et al. Radiation exposure during prostatic artery embolisation: a systematic review and calculation of associated risks. Eur Urol Focus. 2020;4569(20):30111–5.

    Google Scholar 

  10. Malling B, Røder MA, Brasso K, Forman J, Taudorf M, Lönn L. Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis. Eur Radiol. 2019;29(1):287–98. https://doi.org/10.1007/s00330-018-5564-2.

    Article  CAS  PubMed  Google Scholar 

  11. Pisco JM, Bilhim T, Costa NV, et al. Randomised clinical trial of prostatic artery embolisation versus a sham procedure for benign prostatic hyperplasia. Eur Urol. 2020;77(3):354–62.

    PubMed  Google Scholar 

  12. Knight GM, Talwar A, Salem R, Mouli S. Systematic review and meta-analysis comparing prostatic artery embolization to gold-standard transurethral resection of the prostate for benign prostatic hyperplasia. Cardiovasc Intervent Radiol. 2021;44(2):183–93.

    PubMed  Google Scholar 

  13. Jung JH, McCutcheon KA, Borofsky M, et al. Prostatic arterial embolization for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database Syst Rev. 2020;19(12):012867.

    Google Scholar 

  14. Pisco JM, Bilhim T, Pinheiro LC, et al. Medium- and long-term outcome of prostate artery embolization for patients with benign prostatic hyperplasia: results in 630 patients. J Vasc Interv Radiol. 2016;27(8):1115–22.

    PubMed  Google Scholar 

  15. Carnevale FC, Moreira AM, de Assis AM, et al. Prostatic artery embolization for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia: 10 years’ experience. Radiology. 2020;296(2):444–51. https://doi.org/10.1148/radiol.2020191249.

    Article  PubMed  Google Scholar 

  16. Abt D, Müllhaupt G, Hechelhammer L, et al. Prostatic artery embolisation versus transurethral resection of the prostate for benign prostatic hyperplasia: 2-yr outcomes of a randomised, open-label. Single-centre Trial Eur Urol. 2021;80(1):34–42. https://doi.org/10.1016/j.eururo.2021.02.008.

    Article  PubMed  Google Scholar 

  17. Cornelis FH, Bilhim T, Hacking N, Sapoval M, Tapping CR, Carnevale FC. CIRSE standards of practice on prostatic artery embolisation. Cardiovasc Intervent Radiol. 2020;43(2):176–85.

    PubMed  Google Scholar 

  18. McWilliams JP, Bilhim TA, Carnevale FC, et al. Society of interventional radiology multisociety consensus position statement on prostatic artery embolization for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia: from the society of interventional radiology, the cardiovascular and interventional radiological society of Europe, société française de radiologie, and the British society of interventional radiology: endorsed by the Asia pacific society of cardiovascular and interventional radiology, Canadian association for interventional radiology, Chinese college of interventionalists, interventional radiology society of Australasia, Japanese society of interventional radiology, and Korean society of interventional radiology. J Vasc Interv Radiol. 2019;30(5):627–37.

    PubMed  Google Scholar 

  19. Gravas, S., Cornu, J,N., Gacci, M., Gratzke C., Herrmann, T, R, W., Mamoulakis, C., Rieken, M., Speakman, M, J., Tikkinen, K, A, O.: EAU Guidelines on Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO). https://uroweb.org/wp-content/uploads/EAU-Guidelines-on-Management-of-Non-Neurogenic-Male-LUTS-2021.pdf

  20. Lokeshwar SD, Valancy D, Lima TFN, Blachman-Braun R, Ramasamy R. A Systematic review of reported ejaculatory dysfunction in clinical trials evaluating minimally invasive treatment modalities for BPH. Curr Urol Rep. 2020;21(12):54.

    PubMed  Google Scholar 

  21. Lebdai S, Chevrot A, Doizi S, et al. Do patients have to choose between ejaculation and miction? a systematic review about ejaculation preservation technics for benign prostatic obstruction surgical treatment. World J Urol. 2019;37(2):299–308.

    PubMed  Google Scholar 

  22. Wong T, Tembelis M, Acharya V, Hoffmann JC. Prostatic artery embolization and sexual function: literature review and comparison to other urologic interventions. Tech Vasc Interv Radiol. 2020;23(3):100693.

    PubMed  Google Scholar 

  23. Ng BHS, Chung E. A state-of-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):148–58.

    PubMed  PubMed Central  Google Scholar 

  24. Arezki A, Sadri I, Couture F, et al. Reasons to go for Rezum steam therapy: an effective and durable outpatient minimally invasive procedure. World J Urol. 2021;39:2307.

    PubMed  Google Scholar 

  25. Boston Scientific. Instructions for Use Rezūm® Delivery device kit for BPH. https://www.bostonscientific.com/content/dam/elabeling/uro-ph/50998296-01A_Rezum_DFU_en_s.pdf. Accessed 2 Sept 2021.

  26. McVary KT, Rogers T, Roehrborn CG. Rezum water vapor thermal therapy for lower urinary tract symptoms associated with benign prostatic hyperplasia: 4-year results from randomized controlled study. Urology. 2019;126:171.

    PubMed  Google Scholar 

  27. Darson MF, Alexander EE, Schiffman ZJ, et al. Procedural techniques and multicenter postmarket experience using minimally invasive convective radiofrequency thermal therapy with Rezum system for treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Res Rep Urol. 2017;9:159.

    PubMed  PubMed Central  Google Scholar 

  28. Mollengarden D, Goldberg K, Wong D, et al. Convective radiofrequency water vapor thermal therapy for benign prostatic hyperplasia: a single office experience. Prostate Cancer Prostatic Dis. 2018;21:379.

    PubMed  Google Scholar 

  29. Dixon CM, Cedano ER, Pacik D, et al. Two-year results after convective radiofrequency water vapor thermal therapy of symptomatic benign prostatic hyperplasia. Res Rep Urol. 2016;8:207.

    PubMed  PubMed Central  Google Scholar 

  30. Foster HE, Dahm P, Kohler TS, et al. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2019. J Urol. 2019;202:592.

    PubMed  Google Scholar 

  31. Sievert KD, Schonthaler M, Berges R, et al. Minimally invasive prostatic urethral lift (PUL) efficacious in TURP candidates: a multicenter German evaluation after 2 years. World J Urol. 2019;37:1353.

    PubMed  Google Scholar 

  32. Roehrborn CG, Rukstalis DB, Barkin J, et al. Three year results of the prostatic urethral LIFT study. Can J Urol. 2015;22:7772.

    PubMed  Google Scholar 

  33. Magistro G, Chapple CR, Elhilali M, et al. Emerging minimally invasive treatment options for male lower urinary tract symptoms. Eur Urol. 2017;72:986.

    PubMed  Google Scholar 

  34. Roehrborn CG, Barkin J, Gange SN, et al. Five year results of the prospective randomized controlled prostatic urethral LIFT study. Can J Urol. 2017;24:8802.

    PubMed  Google Scholar 

  35. Gratzke C, Barber N, Speakman MJ, et al. Prostatic urethral lift vs transurethral resection of the prostate: 2-year results of the BPH6 prospective, multicentre, randomized study. 2016 BJU Int. 2017;119:767.

    PubMed  Google Scholar 

  36. Roehrborn CG, Gange SN, Shore ND, et al. The prostatic urethral lift for the treatment of lower urinary tract symptoms associated with prostate enlargement due to benign prostatic hyperplasia: the LIFT study. J Urol. 2013;190:2161.

    PubMed  Google Scholar 

  37. Jing J, Wu Y, Du M, et al. Urethral lift as a safe and effective procedure for prostatic hyplasia population: a systematic review and meta-analysis. Front Surg. 2020;7:598728.

    PubMed  PubMed Central  Google Scholar 

  38. Tzeng M, Basourakos SP, Lewicki PJ, et al. New endoscopic in-office surgical therapies for benign prostatic hyperplasia: a systematic review. Eur Urol Focus. 2021;5:741.

    Google Scholar 

  39. Rukstalis D, Grier D, Stroup SP, et al. Prostatic Urethral Lift (PUL) for obstructive median lobes: 12 month results of the MedLift Study. Prostate Cancer Prostatic Dis. 2019;22:411.

    PubMed  Google Scholar 

  40. Magistro G, Stief CG, Woo HH. Mini-review: what is new in urolift? Eur Urol Focus. 2018;4:36.

    PubMed  Google Scholar 

  41. Amparore D, De Cillis S, Volpi G, et al. First- and second-generation temporary implantable nitinol devices as minimally invasive treatments for BPH-related LUTS: systematic review of the literature. Curr Urol Rep. 2019;20:47.

    PubMed  Google Scholar 

  42. Elterman D, Gao B, Zorn KC, et al. How i do it: temporarily implanted nitinol device (iTind). Can J Urol. 2021;28:10788.

    PubMed  Google Scholar 

  43. Amparore D, Fiori C, Valerio M, 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;24:349.

    CAS  PubMed  Google Scholar 

  44. De Nunzio C, Cantiello F, Fiori C, 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;39:2037.

    PubMed  Google Scholar 

  45. Chughtai B, Elterman D, Shore N, et al. The iTind temporarily implanted nitinol device for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia: a multicenter, randomized. Controll Trial Urol. 2021;153:270.

    Google Scholar 

  46. Gilling P, Reuther R, Kahokehr A, et al. Aquablation - image-guided robot-assisted waterjet ablation of the prostate: initial clinical experience. BJU Int. 2016;117:923.

    CAS  PubMed  Google Scholar 

  47. Nguyen DD, Mantri SS, Zorn KC, et al. Which anatomic structures should be preserved during aquablation contour planning to optimize ejaculatory function? a case-control study using ultrasound video recordings to identify surgical predictors of postoperative anejaculation. Urology. 2021;2:41.

    Google Scholar 

  48. Gilling P, Barber N, Bidair M, et al. WATER: a double-blind, randomized, controlled trial of aquablation((R)) vs transurethral resection of the prostate in benign prostatic hyperplasia. J Urol. 2018;199:1252.

    PubMed  Google Scholar 

  49. Gilling P, Barber N, Bidair M, et al. Three-year outcomes after Aquablation therapy compared to TURP: results from a blinded randomized trial. Can J Urol. 2020;27:10072.

    PubMed  Google Scholar 

  50. Bach T, Giannakis I, Bachmann A, et al. Aquablation of the prostate: single-center results of a non-selected, consecutive patient cohort. World J Urol. 2019;37:1369.

    CAS  PubMed  Google Scholar 

  51. Desai M, Bidair M, Bhojani N, et al. Aquablation for benign prostatic hyperplasia in large prostates (80–150 cc): 2-year results. Can J Urol. 2020;27:10147.

    PubMed  Google Scholar 

  52. Elterman DS, Foller S, Ubrig B, et al. Focal bladder neck cautery associated with low rate of post-Aquablation bleeding. Can J Urol. 2021;28:10610.

    PubMed  Google Scholar 

  53. Bilhim T. Prostatic artery embolization and the median lobe: stuck in the middle with you? J Vasc Interv Radiol. 2019;30(11):1817–9. https://doi.org/10.1016/j.jvir.2019.08.003.

    Article  PubMed  Google Scholar 

  54. Pisco J, Bilhim T, Pinheiro LC, et al. Prostate embolization as an alternative to open surgery in patients with large prostate and moderate to severe lower urinary tract symptoms. J Vasc Interv Radiol. 2016;27(5):700–8. https://doi.org/10.1016/j.jvir.2016.01.138.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

Tiago Bilhim received speaker honorarium from Terumo, Merit, Philips and Cook and is a stockholder for Embolx; Patrick Betschart has nothing to disclose; Pavel Lyatoshinsky has nothing to disclose; Gautier Müllhaupt has nothing to disclose; Dominik Abt received speaker honorarium from Janssen and Boston Scientific and has an advisory role for Janssen and Sirtex.

Funding

No funding involved with this study.

Author information

Authors and Affiliations

  1. Department of Radiology, Saint Louis Hospital and NOVA Medical School, Lisbon, Portugal

    Tiago Bilhim

  2. Department of Urology, School of Medicine, University of St. Gallen, St. Gallen, Switzerland

    Patrick Betschart & Gautier Müllhaupt

  3. Department of Urology, Spitalzentrum Biel/Centre Hospitalier Bienne, Bienne, Switzerland

    Pavel Lyatoshinsky & Dominik Abt

Authors
  1. Tiago Bilhim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Betschart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pavel Lyatoshinsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gautier Müllhaupt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dominik Abt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tiago Bilhim.

Ethics declarations

Human and Animal Rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bilhim, T., Betschart, P., Lyatoshinsky, P. et al. 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 45, 415–424 (2022). https://doi.org/10.1007/s00270-021-03052-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-021-03052-4

Keywords

Search

Navigation