Minimally Invasive Surgical Approaches for Bladder Outlet Obstruction Within an Office Environment: A Comprehensive Literature Review

Benign prostatic hyperplasia (BPH) is a common urological disorder in aging men, leading to bladder outlet obstruction (BOO) and lower urinary tract symptoms (LUTS). Traditional surgical treatments are associated with hospitalization, general anesthesia, and potential sexual dysfunction. Minimally invasive surgical techniques (MISTs), such as Rezum, UroLift, and iTIND, offer office-based, local anesthesia options with fewer adverse events. This systematic review evaluates the efficacy, safety, and durability of these MIST procedures. A systematic search of OVID Medline and Embase was conducted in July 2024 using Boolean operators with terms related to BPH and MIST procedures. Inclusion criteria included English language studies using
MIST with a minimum follow-up of 1 year. Data were extracted and analyzed, focusing on functional outcomes, retreatment rates, complications, and anesthesia use. Thirteen studies met inclusion criteria, with a total of 1,864 patients (Rezum 6 studies, 1,292 patients; UroLift 4 studies, 331 patients; and iTIND 3 studies, 241 patients). Rezum, UroLift, and iTIND all demonstrated significant improvements in Qmax and International Prostate Symptom Score (IPSS). Sexual function remained largely preserved. While retreatment rates varied, UroLift had the highest rate (mean: 6.4%). Procedural complications were generally mild, with acute urinary retention being the most frequent. Rezum, UroLift, and iTIND can be done safely and successfully as a
day case procedure usually under local anesthetic. The short-term results are good for all of these procedures and improves objective outcomes as well as preserves or improves sexual function. However, further long-term randomized controlled trials comparing multiple treatment modalities are needed to refine patient selection and
optimize outcomes.

Cite this article as: Harkins J, Talyshinskii A, Somani BK, Jaafari FA. Minimally invasive surgical approaches for bladder outlet obstruction within an office environment: A comprehensive literature review. Urol Res Pract. 2025;51(2):43-53.