Table 2 Statements of the examined guidelines on currently frequently employed and debated procedures

iTIND™

TIPD may be offered as a treatment option for patients with LUTS/BPH provided prostate volume is between 25 and 75 g and lack of obstructive median lobe. (LoE: Grade C)

We recommend that iTIND™ may be offered to men with LUTS interested in preserving ejaculatory function, with prostates 30–80 cc. Patients should be made aware of the higher retreatment rate at 3 years. (LoE: Grade C)

The temporary implantable nitinol basket may serve as an alternative therapy for benign prostatic syndrome in prostates with a volume of up to 75 cubic centimeters and without an endovesical median lobe. Particularly for patients desiring the preservation of ejaculation, therapy with a temporarily implanted nitinol basket can be offered. (LoE: expert opinion)

Randomized controlled trials comparing iTIND™ to a reference technique are ongoing. (LoE: under investigation)

intermediate

PAE

PAE may be offered for the treatment of LUTS/BPH. PAE should be performed by clinicians trained in this interventional radiology procedure following a discussion of the potential risks and benefits. (LoE: Grade C)

At centers with urological and radiological collaboration and technical expertise, highly selected, well-informed patients may be offered PAE if they wish to consider an alternative treatment option. Patients should be informed of lack of long-term durability

(LoE: Grade C)

Prostate artery embolization should be considered for patients with benign prostatic syndrome who are suitable and willing to accept a lesser improvement of objective micturition parameters with this minimally invasive therapy. (LoE: Grade 1++)

Prostatic artery embolisation (PAE) is less effective than TURP at improving symptoms and urodynamic parameters such as flow rate. (LoE: Grade 1a)

Procedural time is longer for PAE compared to TURP, but blood loss, catheterisation and hospitalisation time are in favour of PAE. (LoE: Grade 1b)

high

RASP

Open, laparoscopic, or robotic assisted prostatectomy should be considered as treatment options by clinicians, depending on their expertise with these techniques, only in patients with large to very large prostates. (LoE: Grade C)

We recommend LSP or RASP as alternative surgical therapies for men with moderate-to-severe LUTS/BPS and enlarged prostate volume > 80 cc in centers where there are surgeons with high-level expertise in robotics or laparoscopy. (LoE: Grade B)

The use of modern surgical techniques based on endoscopy and laparoscopy with or without robotic assistance can reduce the risk of complications such as increased blood loss or extended hospital stays, while maintaining the same effectiveness, despite a longer duration of surgery. (LoE: expert opinion)

Minimal invasive simple prostatectomy is feasible in men with prostate sizes > 80 mL needing surgical treatment; however, RCTs are needed.

(LoE: Grade 2a)

low-intermediate

Rezūm™

WVTT should be considered as a treatment option for patients with LUTS/BPH provided prostate volume 30–80 g. (LoE: Grade C)

WVTT may be offered as a treatment option to eligible patients who desire preservation of erectile and ejaculatory function. (LoE: Grade C)

We suggest that the Rezūm™ system of convective water vapor energy ablation may be considered an alternative treatment for men with LUTS interested in preserving ejaculatory function with prostates < 80 cc, including those with a median lobe. (LoE: Grade C)

The Rezūm™ procedure can be a therapeutic option for benign prostatic syndrome in patients who wish to preserve ejaculation. (LoE: Grade 2+)

Randomized controlled trials against a reference technique are needed to confirm the first promising clinical results and to evaluate mid- and long-term efficacy and safety of water vapour energy treatment. (LoE: under investigation)

high