Effects of minimally invasive therapies for benign prostatic hyperplasia on sexual function: focus on the preservation of ejaculation and erection
DOI:
https://doi.org/10.55892/jrg.v9i20.3360Keywords:
Benign Prostatic Hyperplasia, Sexual Health, Ejaculation, Minimally Invasive Surgical Procedures, Quality of LifeAbstract
Benign prostatic hyperplasia (BPH) is a prevalent condition in aging males, whose conventional surgical treatment, although effective in relieving urinary obstruction, historically presents high rates of sexual dysfunction, especially retrograde ejaculation, with an incidence that can reach up to 89% of patients undergoing transurethral resection of the prostate (TURP). This study aimed to analyze the impact of Minimally Invasive Surgical Therapies (MISTs) on the preservation of sexual function. An integrative literature review was conducted, focusing on recent technologies such as UroLift, Rezūm, iTind, and Aquablation. The results indicate that techniques preserving the anatomical integrity of the bladder neck and avoiding thermal energy, notably UroLift and iTind, show ejaculatory function preservation rates near 100%. The Rezūm system also demonstrated high sexual safety, albeit with a temporary risk of urinary retention. Aquablation emerged as an effective alternative for larger prostates, maintaining sexual dysfunction rates significantly lower than those seen in transurethral resection of the prostate (TURP). It is concluded that MISTs represent a fundamental advancement in urology, allowing for individualized therapeutic choices focused on the patient's quality of life, balancing the durability of obstruction relief with the maintenance of male sexual identity.
Downloads
References
CORNU, J. N. et al. Minimally Invasive Treatments for Benign Prostatic Obstruction: A Systematic Review and Network Meta-analysis. European Urology, v. 83, n. 6, p. 534-547, jun. 2023. Disponível em: https://doi.org/10.1016/j.eururo.2023.02.028.
FRANCO, J. V. et al. Minimally invasive treatments for lower urinary tract symptoms in men with benign prostatic hyperplasia: a network meta-analysis. Cochrane Database of Systematic Reviews, v. 7, n. 7, p. CD013656, jul. 2021. Disponível em: https://doi.org/10.1002/14651858.CD013656.pub2.
TOKARSKI, A. T. et al. Aquablation of the prostate: a review and update. The Canadian Journal of Urology, v. 28, n. S2, p. 17-21, ago. 2021.
KNIGHT, L. et al. UroLift for Treating Lower Urinary Tract Symptoms of Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance Update. Applied Health Economics and Health Policy, v. 20, n. 5, p. 669-680, set. 2022. Disponível em: https://doi.org/10.1007/s40258-022-00735-y.
ALCINA, E. L. et al. Expert consensus on Rezūm™: Indications, surgical technique and postoperative care. BJUI Compass, v. 6, n. 2, p. e491, fev. 2025. Disponível em: https://doi.org/10.1002/bco2.491.
COUTEAU, N. et al. Ejaculations and Benign Prostatic Hyperplasia: An Impossible Compromise? A Comprehensive Review. Journal of Clinical Medicine, v. 10, n. 24, p. 5788, dez. 2021. Disponível em: https://doi.org/10.3390/jcm10245788.
BEARELLY, P.; AVELLINO, G. J. The role of benign prostatic hyperplasia treatments in ejaculatory dysfunction. Fertility and Sterility, v. 116, n. 3, p. 611-617, set. 2021. Disponível em: https://doi.org/10.1016/j.fertnstert.2021.07.1199.
WARLI, S. M. et al. The efficacy and safety of prostatic urethral lift as a minimally invasive therapeutic modality to treat lower urinary tract symptoms while maintaining sexual function in patients with benign prostatic hyperplasia: a systematic review and meta-analysis of randomized controlled trials. Archivio Italiano di Urologia e Andrologia, v. 96, n. 1, p. 12066, mar. 2024. Disponível em: https://doi.org/10.4081/aiua.2024.12066.
HWANG, E. C. et al. Aquablation of the prostate for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database of Systematic Reviews, v. 2, n. 2, p. CD013143, fev. 2019. Disponível em: https://doi.org/10.1002/14651858.CD013143.pub2.
MCVARY, K. T.; EL-ARABI, A.; ROEHRBORN, C. Preservation of Sexual Function 5 Years After Water Vapor Thermal Therapy for Benign Prostatic Hyperplasia. Sexual Medicine, v. 9, n. 6, p. 100454, dez. 2021. Disponível em: https://doi.org/10.1016/j.esxm.2021.100454.
DENISENKO, A.; SOMANI, B.; AGRAWAL, V. Recent advances in UroLift: A comprehensive overview. Turkish Journal of Urology, v. 48, n. 1, p. 11-16, jan. 2022. Disponível em: https://doi.org/10.5152/tud.2022.21149.
NIU, X.; LIU, B. Six novel minimally invasive therapies for benign prostatic hyperplasia. Zhejiang Da Xue Xue Bao Yi Xue Ban, v. 52, n. 2, p. 162-168, abr. 2023. Disponível em: https://doi.org/10.3724/zdxbyxb-2022-0593.
GILLING, P. J. et al. Five-year outcomes for Aquablation therapy compared to TURP: results from a double-blind, randomized trial in men with LUTS due to BPH. The Canadian Journal of Urology, v. 29, n. 1, p. 10960-10968, fev. 2022.
TRIANTAFYLLOU, P. et al. Complication Profile and Safety Outcomes of Aquablation in the Management of BPH. Medicina (Kaunas), v. 61, n. 12, p. 2076, nov. 2025. Disponível em: https://doi.org/10.3390/medicina61122076.
VAN KOLLENBURG, R. A. A. et al. Novel minimally invasive treatments for lower urinary tract symptoms: a systematic review and network meta-analysis. International Braz J Urol, v. 49, n. 4, p. 411-427, jul./ago. 2023. Disponível em: https://doi.org/10.1590/S1677-5538.IBJU.2023.0016.
DEY, A. et al. Emerging Technologies for the Surgical Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Obstruction. A Systematic Review. European Urology Focus, v. 10, n. 3, p. 400-409, maio 2024. Disponível em: https://doi.org/10.1016/j.euf.2023.09.003.
FRANCO, J. V. et al. Transurethral microwave thermotherapy for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database of Systematic Reviews, v. 6, n. 6, p. CD004135, jun. 2021. Disponível em: https://doi.org/10.1002/14651858.CD004135.pub4.
ALTMAN, R. et al. Comparing prostatic artery embolization to surgical and minimally invasive procedures for the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis. BMC Urology, v. 24, n. 1, p. 22, jan. 2024. Disponível em: https://doi.org/10.1186/s12894-023-01397-1.
ELTERMAN, D. et al. An Evaluation of Sexual Function in the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia in Men Treated with the Temporarily Implanted Nitinol Device. Journal of Endourology, v. 37, n. 1, p. 74-79, jan. 2023. Disponível em: https://doi.org/10.1089/end.2022.0226.
AKGUL, B. et al. Impact of minimally invasive surgical therapies on sexual function in benign prostatic hyperplasia: a systematic review. Minerva Urology and Nephrology, v. 77, n. 4, p. 459-471, ago. 2025. Disponível em: https://doi.org/10.23736/S2724-6051.25.06374-8.
JUNG, J. H. et al. Prostatic urethral lift for the treatment of lower urinary tract symptoms in men with benign prostatic hyperplasia. Cochrane Database of Systematic Reviews, v. 5, n. 5, p. CD012832, maio 2019. Disponível em: https://doi.org/10.1002/14651858.CD012832.pub2.
CAHILL, E. M. et al. The impact of minimally invasive surgical therapy for Benign prostatic hyperplasia on sexual function: a systematic review and meta-analysis. Prostate Cancer and Prostatic Diseases, mar. 2026. Disponível em: https://doi.org/10.1038/s41391-026-01091-x.
CHECCUCCI, E. et al. New Ultra-minimally Invasive Surgical Treatment for Benign Prostatic Hyperplasia: A Systematic Review and Analysis of Comparative Outcomes. European Urology Open Science, v. 33, p. 28-41, set. 2021. Disponível em: https://doi.org/10.1016/j.euros.2021.08.009.
ZHANG, X. et al. Minimally invasive treatments for benign prostatic hyperplasia: A narrative review. Medicine (Baltimore), v. 105, n. 12, p. e47951, mar. 2026. Disponível em: https://doi.org/10.1097/MD.0000000000047951.
CHENG, C. et al. A mechanistic, imaging-based classification of complete retrograde ejaculation: insights from dynamic transrectal ultrasonography. European Journal of Medical Research, mar. 2026. Disponível em: https://doi.org/10.1186/s40001-026-04159-5.
SOCIEDADE BRASILEIRA DE UROLOGIA (SP). Manual de urologia. Editores: Archimedes Nardozza Júnior, Rodolfo Borges dos Reis, Rodrigo Sousa Madeira Campos. São Paulo: Planmark, 2010.
SOCIEDADE BRASILEIRA DE UROLOGIA (SP). Urologia fundamental. Editores: Archimedes Nardozza Júnior, Miguel Zerati Filho, Rodolfo Borges dos Reis. São Paulo: Planmark, 2010.
