Impact of minimally invasive surgical therapies on sexual function in benign prostatic hyperplasia: a systematic review.

Introduction: Technological advancements in minimally invasive surgical therapies(MIST) have altered the management of benign prostatic hyperplasia (BPH), offering reduced morbidity and better preservation of sexual functions compared to traditional surgical methods. The study aimed to systematically evaluate the effects of MISTs on erectile and ejaculatory functions in patients with BPH.

Evidence acquisition: A systematic literature search was performed in Medline(PubMed), Embase (Ovid), and Cochrane Library (up to December 2024) following PRISMA guidelines (PROSPEROCRD42024541279). Retrospective and prospective studies were included, focusing on changes in the International Index of Erectile Function (IIEF-5) and the Male Sexual Health Questionnaire-Ejaculatory Dysfunction (MSHQ-EjD; Function and/or Bother) scales, alongside the incidence of erectile (ED) and ejaculatory dysfunction (EjD) following MISTs.

Evidence synthesis: Out of 743 studies, 79 met the inclusion criteria. EjD was reported for water vapor thermal therapy (WVTT) as 3.2% and 10.8% at 6- and 12-month follow-ups, respectively. For Aquablation, the rates were 15% at 6 months, 7% at 5 years, and at 3 years, 9.7% in younger and 12% in older patients. For Prostatic Artery Embolization(PAE), EjD was reported as 13.3% at 1 year and 56% at 2 years. ED rates were 6.8% at 10 years for Transurethral Needle Ablation(TUNA) and 1% at 5 years for transurethral microwave therapy (TUMT). Erectile function was largely preserved except for radiology-based techniques.

Conclusions: This review underscores the superiority of MISTs in preserving erectile and ejaculatory functions compared to conventional treatments, particularly with PUL, Temporarily implantable nitinol device (iTIND), and the optilume BPH catheter system. While ED is largely preserved except for radiology-based techniques, EjD remains a potential risk.