Trends for ejaculatory sparing and minimally invasive surgical treatments adoption for lower urinary tract symptoms related to BPH in Italy: screenshot from the Italian society of urology (SIU) benign research network

Abstract

Background: Minimally invasive surgical treatments (MISTs) for benign prostatic hyperplasia (BPH) are increasingly adopted due to fewer complications and better preservation of ejaculatory function. However, real-world data on patient selection and clinical application in Italy remain scarce.

Methods: Patients undergoing Aquablation, Rezum, iTIND, TPLA, or PUL from October 2022 to December 2024 were prospectively enrolled by 15 Italian centers in the SIU Research Network. Baseline clinical, anatomical, and functional data were collected via a secure digital platform. Data were recorded using standardized electronic case report forms, and patient-reported outcomes were gathered through validated questionnaires administered at baseline and during follow-up.

Results: A total of 312 patients were enrolled: 30 (9.6%) Aquablation, 97 (31.1%) Rezum, 49 (15.7%) iTIND, 108 (34.6%) TPLA, and 28 (9.0%) PUL. iTIND patients were the youngest (median age 47, IQR 42-57), had the lowest prostate volume (30 mL, IQR 27.5-40), lowest comorbidity scores, and poorest Qmax (6.2 mL/s, IQR 5-8). Aquablation and TPLA were adopted for larger prostates (70 mL, IQR 50-80 and 67 mL, IQR 45-85, respectively). Median lobe was most frequent in Rezum (56.7%) patients. PUL patients had the lowest post-void residual (20 mL, IQR 5-60). Rezum and TPLA patients reported better ejaculatory function (P<0.02), while iTIND patients showed the highest dysfunction (P<0.05). Baseline QoL scores were comparable across groups.

Conclusions: This interim analysis shows that MIST adoption in Italy is influenced by prostate size, age, comorbidities, and functional profiles. The findings describe baseline selection patterns only, with postoperative outcomes to be reported in future analyses.