EFFICACY, SAFETY, DURABILITY, AND SEXUAL OUTCOMES OF INTERVENTIONAL THERAPIES FOR BENIGN PROSTATIC OBSTRUCTION: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective: To compare the efficacy, safety, durability, and sexual outcomes of the main interventional therapies used for lower urinary tract symptoms (LUTS) attributed to benign prostatic obstruction (BPO). Methodology: PubMed/MEDLINE, Scopus, and LILACS were searched for studies published between January 2011 and July 30, 2026. Comparative studies evaluating Aquablation, Rezūm, UroLift, iTind, prostatic artery embolization (PAE), holmium laser enucleation of the prostate (HoLEP), other forms of laser enucleation of the prostate (LEP), and transurethral resection of the prostate (TURP) were included. The main efficacy outcomes were the International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax), complemented by postvoid residual volume, safety, sexual function, retreatment, and durability. Results: Twelve publications were included, representing a smaller number of independent cohorts because some reports were secondary analyses or long-term follow-ups of previously published studies. All interventions improved urinary symptoms, although differences were observed in the degree of deobstruction, safety, sexual preservation, and need for additional treatment. TURP and laser enucleation produced greater objective functional improvement. Aquablation showed comparable symptom improvement across different settings and was associated with a lower frequency of ejaculatory dysfunction. PAE improved symptoms but generally produced smaller functional gains than TURP, while showing favorable results compared with pharmacological treatment. UroLift, Rezūm, and iTind demonstrated favorable sexual-function preservation, with differences in durability and retreatment rates. Exploratory meta-analysis of Aquablation versus laser enucleation showed no consistent difference in IPSS, whereas objective functional parameters tended to favor enucleation, although estimates remained uncertain because of the small number of studies. Conclusion: No single intervention was superior across all evaluated outcomes. Treatment selection should integrate symptom improvement, deobstruction requirements, safety, sexual-function preservation, prostate characteristics, and expected durability.