The current reality and future prospects of less invasive technology for the treatment of BPH

Published in: Urol List 2013; 11(2): 25-32


The aim of this article is to present an overview of the current option of minimally invasive therapy of benign prostatic hyperplasia. The article focuses on the basic principles of each method, its effectivenessand the current use of these techniques. In the article are also discuss the possibilities of usinglasers in surgical treatment, although they are not minimally invasive procedures in the true sense ofthe word. Included, at the end of this article, are two new methods which were presented at the EAU Congress 2013 in Milan.

Key words:
benign prostatic hyperplasia, miniinvasive therapy, TUMT, HIFU, TUNA, lasers, stents, Rezūm™


1. Ponholzer A, Marszalek M, Madersbacher S. Minimally invasive treatment of BPH: an update. EAU Update Series 2004; 2: 24–33.

2. Tubaro A, Vicentini C, Renzetti R, Miano L. Invasive and minimally invasive treatment modalities for lower urinary tract symptoms: what are the relevant differences in randomised controlled trials. Eur Urol 2000; 38 (Suppl 1): 7–17.

3. Hoffman RM, Monga M, Elliot S et al. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev 2007; (4): CD004135.

4. Mattiasson A, Wagrell L, Schelin S et al. Five-year follow-up of feedback microwave thermotherapy versus TURP for clinical BPH: a prospective randomised multicenter study. Urology 2007; 69(1): 91–6.

5. Xu WF, Zhang HB, Lin Z et al. Transrectal high-intensity focused ultrasound for treatment of benign prostatic hyperplasia: report of 262 cases. Nan Fang Yi Ke Da Xue Xue Bao. 2010; 30(8): 1906–1908.

6. Madersbacher S, Schatzl G, Djavan B, Stulnig T, Marberger M. Long-term outcome of transrectal highintensity focused ultrasound herapy for benign prostatic hyperplasia. Eur Urol 2000; 37: 687–694.

7. Chapple CR, Issa MM, Woo H. Transurethral needle ablation (TUNA). A critical review of radiofrequency thermal therapy in the management of benign prostatic hyperplasia. Eur Urol 1999; 35: 119–128.

8. Bruskewitz R, Issa MM, Roehrborn CG et al. A prospective, randomized 1-year clinical trial comparing transurethral needle ablation to transurethral resection of the prostate for the treatment of symptomatic benign prostatic hyperplasia. J Urol 1998; 159: 1588–1594.

9. Zlotta AR, Giannakopoulos X, Maehlum O, Ostrem T, Schulman CC. Long-term evaluation of transurethral needle ablation of the prostate (TUNA) for treat­ment of symptomatic benign prostatic hyperplasia: clinical outcome up to five years from three centers. Eur Urol 2003; 44: 89–93.

10. Benoist N, Bigot P, Colombel P et al. Tuna: Clinical retrospective study addressing mid-term outcomes. Prog Urol 2009; 19(1): 54–9.

11. První zkušenosti s metodou TUNA (transurethral needle ablation) při léčbě BPH v ČR, P. Kumstát, D. Pacík, Urologická klinika FN Brno-Bohunice, Ces Urol 2002; 6 (1): 12–16.

12. Vanderbrink BA, Rastinehad AR, Badlani GH. Prostatic stents for the treatment of benign prostatic hyperplasia. Curr Opin Urol 2007; 17(1): 1–6.

13. Armitage JN, Cathcart PJ, Rashidian A et al. Epithelializing Stent for Benign Prostatic Hyperplasia: A Systematic Review of the Literature. J Urol 2007 May; 177(5): 1619–1624.

14. Westenberg A, Gilling P, Kennett K et al. Holmium laser resection of the prostate versus transurethral resection of the prostate: results of a randomised trial with 4-year minimum long-term followup. J Urol 2004 Aug; 172(2): 616–619.

15. Kuntz RM, Lehrich K, Ahyai SA. Holmium laser enucleation of the prostate versus open prostatectomy for prostates greater than 100 grams: 5-year follow-up results of a randomised clinical trial. Eur Urol 2008 Jan; 53(1): 160–166.

16. Rieken M., Bachmann A. Vaporizace prostaty pomocí zeleného laseru (GreenLight laser) – zkušenost z jednoho centra po provedení více než 1 000 výkonů, Urol List 2012; 10(4): 22–26.

17. Al-Ansari A et al. GreenLight HPS 120-W laser vaporization versus transurethral resection of the prostate for treatment of benign prostatic hyperplasia: a randomized clinical trial with midterm follow-up. Eur Urol. 2010 Sep; 58(3): 349–55.

18. Babjuk M, Dvořáček J, Janský M et al. Transuretrální intersticiální laserová koagulace a její využití v léčbě benigní hyperplazie prostaty. Endoskopie 2000; 9: 4–7.

19. Kursh ED, Concepcion R, Chan S et al. Interstitial laser coagulation versus transurethral prostate resection for treating benign prostatic obstruction: a randomized trial with 2-year follow-up. Urology 2003; 61: 573–578.

20. Herrmann T et al. Thulium laser enucleation of the prostate (ThuLEP): transurethral anatomical prostatectomy with laser support. Introduction of a novel technique for the treatment of benign prostatic obstruction World J Urol 2010; 28: 45–51.

21. Goya N, Ishikawa N, Ito F et al. Transurethral ethanol injection therapy for prostatic hyperplasia: 3-year results. J Urol 2004; 172(3): 1017–20.

22. Nikoobakht M, Daneshpajooh A, Ahmadi H et al. Intraprostatic botulinum toxin type A injection for the treatment of benign prostatic hyperplasia: initial experience with Dysport. Scand J Urol Nephrol 2010; 44(3): 151–7.

23. Maria G, Brisinda G, Civello IM et al. Relief by botulinum toxin of voiding dysfunction due to benign prostatic hyperplasia: results of a randomised, placebo-controlled study. Urology 2003; 62(2): 259–64.

24. Kuo HC, Liu HT. Therapeutic effects of add-on botulinum toxin A on patients with large benign prostatic hyperplasia and unsatisfactory response to combined medical therapy. Scand J Urol Nephrol 2009; 43(3): 206–11.

25. Dixon C, Rijo CE, Pacik D, Vit V, Varga V et al. Transurethral water vapor therapy for BPH; initial clinical results of the first in man trial and Rezūm™ I pilot study. European Urology Supplements, Volume 12, Issue 1 , Page e631, March 2013.

26. Miller F, Schönthaler M et al. The Prostatic Urethral Lift (PUL), a minimal-invasive transurethrally-placed implant, proves its efficacy in the treatment of LUTS in patients with BPH in daily clinic practice outside of studies, European Urology Supplements Volume 12, Issue 1, Pages ­­e629–­e630, March 2013.

Paediatric urologist Urology
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