Ablative Minimally Invasive Surgical Therapies for Benign Prostatic Hyperplasia: A Review of Aquablation, Rezum, and Transperineal Laser Prostate Ablation - Beyond the Abstract

The global burden of benign prostatic hyperplasia (BPH) presents a significant challenge for healthcare systems, affecting millions of older men worldwide. This progressive condition results in lower urinary tract symptoms (LUTS), significantly impacting patients' quality of life. With an aging global population, the demand for effective BPH treatments has been growing, contributing to a backlog of surgeries and further straining healthcare resources.

Amid these challenges, patients' interest in surgical options that preserve sexual function remains strong, as it plays a vital role in their overall well-being.1 Minimally invasive surgical treatments such as Aquablation therapy, convective water vapor therapy (Rezūm), and transperineal prostate laser ablation (TPLA), which belong to the category of ablative technologies, have the potential to address this growing demand and offer a better safety profile with preservation of sexual function for BPH patients.

Given this context,2 we reviewed three ablative minimally invasive therapies for LUTS due to BPH - Aquablation, Rezūm, and TPLA. We summarized the literature available for each technology focusing on describing the surgical technique, perioperative outcomes, complications, and functional and sexual outcomes. Our findings revealed that while each modality has unique strengths - an office-based setting for Rezūm and TPLA and Aquablation's strong efficacy at the five-year follow-up - all three ablative technologies presented promising evidence of safety and effectiveness. Notably, this included the preservation of ejaculation and erectile function in both trial and real-world data.

Our research contributes to the growing body of evidence that minimally invasive ablative surgeries provide safe and effective treatment for BPH and do so while preserving sexual function. The comparison of these technologies helps healthcare providers to deliver more targeted and personalized therapies. These findings carry significant implications for the management of BPH. They reinforce the importance of shared decision-making between patients and their urologists and emphasize the need to incorporate patients' values and preferences into treatment decisions. Additionally, they emphasize the importance of providing patients with reliable and comprehensible resources, such as the CUA BPH Decision Aid, to support their decision-making process.3

While our research underscores the efficacy and safety of these three minimally invasive ablative procedures as options for individualized patient care, it also revealed that evaluating these treatments should not end here. Continued surveillance through observational studies is required to maintain a comprehensive understanding of these procedures’ long-term implications and possible unforeseen side effects. Head-to-head comparisons and reviews with network meta-analysis targeting other innovative minimally invasive surgical therapies (MISTs), such as prostatic stents, are crucial to understanding the comparative effectiveness of different surgical BPH treatments that preserve sexual function.

Written by:

  • Roseanne Ferreira, MD, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
  • David-Dan Nguyen, MDCM, MPH, Division of Urology, University of Toronto, Toronto, ON, Canada
  • Tiange Li, MD, Division of Urology, University of Toronto, Toronto, ON, Canada
  • Mohamad Baker Berjaoui, MD, Division of Urology, University of Toronto, Toronto, ON, Canada
  • Anna-Lisa V. Nguyen,BHSc, Schulich School of Medicine and Dentistry, Western University, London, Ontario, CA
  • Bilal Chughtai, MD, Department of Urology, Weill Cornell Medical College, New York, NY, USA
  • Kevin C. Zorn, MD, Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, CA
  • Naeem Bhojani, MD, Division of Urology, Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, QC, CA
  • Dean S. Elterman, MD, MSc, Division of Urology, University of Toronto, Toronto, ON, Canada


  1. Bouhadana, D., Nguyen, D.-D., Zorn, K. C., Elterman, D. S. & Bhojani, N. Patient Perspectives on Benign Prostatic Hyperplasia Surgery: A Focus on Sexual Health. J. Sex. Med. 17, 2108–2112 (2020).
  2. Nguyen, D.-D. et al. Ablative minimally invasive surgical therapies for benign prostatic hyperplasia: A review of Aquablation, Rezum, and transperineal laser prostate ablation. Prostate Cancer Prostatic Dis. (2023)
  3. Bouhadana, D. et al. Evaluating the acceptability of an online patient decision aid for the surgical management of lower urinary tract symptoms secondary to benign prostatic hyperplasia. Can. Urol. Assoc. J. 15, 247–254 (2021).
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