Novel minimally invasive treatment options for male lower urinary tract symptoms

The main objective of novel minimally invasive treatment options is to be equally effective to current reference techniques while providing a superior safety profile. Especially the preservation of sexual function, including ejaculatory function, is of great interest to patients facing surgical treatment of lower urinary tract symptoms (LUTS). Ideally, a truly minimally invasive procedure can be performed under local anaesthesia in an outpatient setting. Among emerging medical devices, the prostatic urethral lift (PUL; Urolift) demonstrated rapid and durable relief of LUTS in selected patients without a prominent middle lobe. Compared to the reference method TURP, it was superior in terms of preservation of sexual function and recovery experience. The first clinical evaluation of the "Temporary Implantable Nitinol Device" (TIND) proved its feasibility, efficacy and safety for the treatment of LUTS over a 3-year follow-up period. However, prospective randomised controlled trials are still needed to evaluate its true benefit. New ablative technologies like Rezum are based on convective water vapour energy and have shown good results in a sham-controlled randomised clinical trial for the treatment of LUTS over a follow-up period of 3 years. Of note, this procedure was also successful in patients with a prominent middle lobe, and no impairment of sexual function was reported after Rezum. Innovative technologies like Aquablation AquaBeam) are still in their infancy, but the first clinical outcomes are promising, even in comparison with the reference method TURP.