The impact of minimally invasive surgical therapy for Benign prostatic hyperplasia on sexual function: a systematic review and meta-analysis.

INTRODUCTION

Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) can significantly impair a man's quality of life. While traditional surgical treatments are effective, they often pose risks to sexual function, particularly in the form of ejaculatory and/or erectile dysfunction. Minimally invasive surgical treatments (MISTs) have emerged as alternative procedures that aim to alleviate LUTS while preserving sexual function.

OBJECTIVE

Investigate the impact of MISTs for BPH on sexual function including erectile and ejaculatory function.

METHODS

In May 2025, a systematic review and meta-analysis of sexual function outcomes in MISTs was performed using the Ovid, Embase, and Medline/PubMed databases. Articles were included if they were in English, assessed a MIST, and incorporated sexual function outcomes. Articles were excluded if they included pooled analyses, were abstracts without full text, and/or were ongoing incomplete clinical trials. We included studies on water vapor thermal therapy (Rezum), prostatic urethral lift (Urolift), prostatic artery embolization (PAE), temporary implantable nitinol device (iTIND), Optilume BPH catheter system, and transperineal laser ablation (TPLA). Outcomes included erectile function using International Index of Erectile Function (IIEF) scores and ejaculatory function using the Male Sexual Health Questionnaire (MSHQ).

RESULTS

The initial search yielded 2646 studies. After screening and full text review, 77 studies met inclusion criteria encompassing a total of 11,477 patients. Based on the pooled analyses, IIEF scores significantly improved after Rezum and Urolift. Urolift significantly improved MSHQ-function and bother scores, while Rezum only improved MSHQ-bother scores. PAE, iTind, Optilume, and TPLA did not significantly impact erectile or ejaculatory function.

CONCLUSIONS

MISTs are a promising option for management of BPH in patients interested in maintaining sexual function, preserving or even improving erectile and ejaculatory function.