Reintervention rates after minimally invasive benign prostatic hyperplasia therapies: a systematic review including industry involvement.

PURPOSE: Minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia (BPH) provide effective alternatives to traditional surgery. At the same time, long-term reintervention rates and industry sponsorship influence remain critical in clinical decision-making. We systematically assessed surgical reintervention rates, medical therapy initiation following MISTs, and the impact of industry sponsorship on study outcomes.

METHODS

We systematically reviewed prospective and retrospective studies in MEDLINE, EMBASE, and Cochrane Library (up to December 2024) according to PRISMA guidelines (CRD42024617974). Risk analysis evaluated conflicts of interest (COI) and sponsor influence.

RESULTS

Of 99 studies, surgical reintervention rates were 13.6% for Prostatic Urethral Lift(PUL) (5 years), 11.1% for Water Vapor Thermal Therapy(WVTT)(5 years), 4.4%-6% for Aquablation (5 years), 21% for Prostatic Artery Embolization(PAE) (2 years), 2.5% for Optilume BPH Catheter System(OBCS) (2 years), 11.1% for Temporarily Implantable Nitinol Device (iTIND) (4 years), 13.8%-26.4% for Transurethral Needle Ablation(TUNA) (5-10 years), and 67% for Transurethral Microwave Therapy (TUMT) (5 years). Medical therapy initiation rates reached 10.7% for PUL (5 years), 11.1% for WVTT (5 years), 4.4% for Aquablation (5 years), 2.5% for OBCS (4 years), and 24.5% for TUMT (5 years). Industry sponsorship was high-risk in 65% of studies, and sponsor influence was 52%, raising objectivity concerns. Variability in follow-up durations and therapy initiation rates limits comparability.

CONCLUSIONS

PAE, TUMT, and TUNA show higher reintervention rates, while OBCS (4 years) and both Aquablation and WVTT (5 years) demonstrate lower rates. Industry-sponsored studies often apply restrictive inclusion, yielding favorable results that may not fully translate to broader, real-world populations. Caution is needed when integrating these findings into clinical guidelines, particularly given potential COI.