Open Access

EXPERT OPINION

Is it time to offer True Minimally Invasive Treatments (TMIST) for BPH? – A review of office-based therapies and introduction of a new technology category

Dean S. Elterman¹, Kevin C. Zorn², Bilal Chughtai³, Naeem Bhojani²

1 Division of Urology, University Health Network, University of Toronto, Toronto, Ontario, Canada
2 Department of Surgery, University of Montreal (CHUM), Montreal, Quebec, Canada
3 Department of Urology, Weill Cornell Medical College, New York, New York, USA
Address correspondence to Dr. Dean S. Elterman, Toronto Western Hospital, Main Pavilion, 8^th Floor, Room 317, 399 Bathurst Street, Toronto, ON M5T 2S8 Canada

Canadian Journal of Urology 2021, 28(2), 10580-10583.

Abstract

Introduction: The options for treating benign prostatic hyperplasia (BPH) beyond medication and traditional transurethral surgery continue to expand. Undesirable side effects of medication and surgeries have driven interest toward minimally invasive surgical therapies (MISTs), including convective water vapor ablation (Rezum) and prostatic urethral lift (UroLift). While these treatments can be performed outside of the operating room, they do require special equipment and the use of rigid cystoscopy. A new class of treatments, which utilize no special equipment beyond a flexible cystoscope, is emerging, the first of which, the temporary implantable nitinol device (iTind), is already FDA approved.
Materials and methods: A comprehensive review of the literature using PUBMED, EMBASE, and Scopus focused on the two commercially available MISTs, Rezum and UroLift, was performed. Additionally, we evaluated the existing literature for the novel iTind.
Results: UroLift and Rezum have demonstrated significant improvements in validated questionnaires such as IPSS and IPSS QoL. They generally maintain erectile function (IIEF) and ejaculatory function (MSHQ). Short-term recovery seems to slightly favor UroLift, while re-treatment rates seem to favor Rezum. The iTind also appears to improve subjective and objective outcomes, though longer-term follow-up is still maturing.
Conclusion: The currently available MISTs have changed the way we treat BPH, offering a middle ground for men between oral medical therapy and more invasive transurethral surgery. While these MIST treatments require specialized and costly equipment, the proposed new category, True Minimally Invasive Surgical Therapy (TMIST), offers an off-the-shelf, affordable, and comfortable solution for men suffering from LUTS secondary to BPH.

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