What does this research mean for the field?

Minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia (BPH) can preserve or improve sexual function, specifically erectile and ejaculatory function, in patients. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

Investigate the effects of minimally invasive surgical treatments (MISTs) for BPH on erectile and ejaculatory function.

March 5, 2026Prostate Cancer and Prostatic Diseases2 citationsOpen Access

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

ECEllen M. CahillYale University MLMarcelo Mass LindenbaumCleveland Clinic AEAlexander EstrightUniversity School

Key Points

Investigate the effects of minimally invasive surgical treatments (MISTs) for BPH on erectile and ejaculatory function.
Systematic review and meta-analysis conducted in May 2025
Searched Ovid, Embase, and Medline/PubMed databases
Included studies evaluating MISTs and sexual function outcomes
Assessments based on IIEF and MSHQ scores
77 studies with 11,477 patients included after screenings.
IIEF scores significantly improved after Rezum and Urolift treatments.
Urolift improved both MSHQ-function and bother scores; Rezum improved only MSHQ-bother scores.
PAE, iTIND, Optilume, and TPLA showed no significant impact on sexual function.

Abstract

Abstract 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.

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