The Minimally Invasive Era for BPH: An Overview of the Landscape

In this video, C. Shawn West, MD, a urologist with McIver Urological Clinic in Florida, examines the modern landscape of minimally invasive surgical therapies for benign prostatic hyperplasia (BPH), emphasizing safety and patient experience as primary determinants of clinical value. He notes that beyond efficacy, how patients perceive the procedure and recovery plays a critical role in long-term satisfaction and perceived success.

West contrasts mechanical tissue-lifting implants with energy-based ablative therapies, highlighting a central trade-off between preservation of sexual function and the ability to treat larger prostates. Mechanical approaches offer symptom relief while minimizing sexual side effects, whereas ablative modalities, such as photoselective vaporization, may carry a higher risk of retrograde ejaculation despite their effectiveness in debulking tissue.

Water-based ablation techniques are discussed as an intermediate option, offering efficacy for larger glands but requiring hospitalization and longer recovery. West also evaluates emerging technologies, including prostatic stents, noting that although innovation is promising, robust long-term durability data remain limited. He underscores the importance of evidence quality, including registry data, in guiding clinical decision-making and reinforcing confidence in established therapies.