Benign prostatic hyperplasia (BPH) is a major cause of lower urinary tract symptoms (LUTS) and is frequently associated with erectile and ejaculatory dysfunction. Although transurethral resection of the prostate (TURP) remains an effective treatment for symptom relief, its negative impact on sexual function has driven increasing interest in minimally invasive surgical therapies (MISTs) that aim to preserve sexual outcomes. This narrative review summarizes contemporary evidence on urinary and sexual outcomes following major MISTs, including iTIND™, UroLift™, Rezum™, Aquablation, transperineal laser ablation (TPLA), prostatic artery embolization (PAE), and the drug-coated balloon system Optilume BPH™. Across studies, most modalities demonstrated reductions in the International Prostate Symptom Score of 7.8-17 points and improvements in maximum urinary flow rate of 3-12 mL/s, though the magnitude of effect and durability varied. UroLift™ and TPLA consistently demonstrated strong ejaculation-sparing effects, owing to their non-ablative or highly selective mechanisms. Rezum™ and Aquablation provided durable symptom relief with low rates of de novo erectile dysfunction and mostly transient ejaculatory changes. PAE offered excellent sexual preservation but comparatively less pronounced urinary improvements. Early data on Optilume BPH™ suggest sustained LUTS/BPH improvement with reliable maintenance of sexual function. MISTs represent established alternatives to TURP; however, given heterogeneity in study populations, follow-up durations, and outcome definitions, conclusions should be interpreted cautiously.
International journal of impotence research. 2026 Apr 20 [Epub ahead of print]
Ahmet Tevfik Albayrak, Muhammet Volkan Bulbul, Andre Rubez, Adriano Fregonesi, Ege Can Serefoglu
University of Health Sciences Sisli Hamidiye Etfal Training and Research Hospital, Urology Department, Istanbul, Turkey. ., Agri Ibrahim Cecen University, School of Medicine, Histology and Embryology Department, Agri, Turkey., Unicamp, School of Medicine, Urology Department, Campinas, Brazil., Biruni University, School of Medicine, Urology Department, Istanbul, Turkey.