ABSTRACT

During the last decade various modalities for minimal invasive therapy of benign prostatic hyperplasia have been developed as alternative to monopolar transurethral resection of the prostate (TURP) which is the “gold standard”. Although bipolar systems, holmium laser enucleation of the prostate (HoLEP) and photoselective vaporization of the prostate (PVP) are good candidates to be “gold standard”, they are not ideal minimal invasive therapeutic options as alternative to medical management due to necessity of anesthesia. Transurethral microwave thermotherapy (TUMT), transurethral needle ablation (TUNA), hot water induced thermotherapy (WIT), interstitial laser coagulation (ILC), prostatic stents, intraprostatic ethanol injection and botulinum toxin A injection might replace medical therapy as the minimal invasive options.

TUMT seemed to be optimum alternative to medical management and TURP, because of its proven long-term efficiency, plus it can be performed in an outpatient setting without the need of anesthesia. Since high intensity focused ultrasound is performed under anesthesia, it should not be considered as a minimally invasive treatment option. Results of this expensive treatment are quite poor. TUNA, WIT and ILC found as promising therapies, but long-term results are insufficient. Intraprostatic ethanol and botulinum toxin A injection are safe and promising modalities, but larger series with longer follow-up are needed to confirm its efficacy.