HISTORY AND CURRENT STATUS OF MINIMALLY INVASIVE TREATMENTS FOR BENIGN PROSTATIC HYPERPLASIA: FROM OPEN SURGERY TO ULTRA-MINIMALLY INVASIVE THERAPIES

Relevance. Benign prostatic hyperplasia remains one of the most common urological diseases and a leading cause of lower urinary tract symptoms in older men. The expanding range of endoscopic, laser, and ultra-minimally invasive interventions requires a structured overview of their historical development and current clinical role.

Aim. To analyze the evolution of surgical treatment for benign prostatic hyperplasia from open adenomectomy and transurethral resection of the prostate to contemporary laser and ultra-minimally invasive techniques.

Materials and Methods. A narrative review of the literature, recommendations of the European Association of Urology and the American Urological Association, and key meta-analyses was performed. Technical features, advantages, limitations, and the current clinical role of the methods were assessed.

Results. Surgical treatment for benign prostatic hyperplasia evolved from open procedures to transurethral resection of the prostate, which long remained the gold standard, and subsequently to bipolar resection and laser techniques, particularly holmium laser enucleation of the prostate, thulium laser enucleation of the prostate, and photoselective vaporization of the prostate. More recently, ultra-minimally invasive approaches, including prostatic urethral lift, water vapor thermal therapy, robotic waterjet ablation, prostatic artery embolization, and a temporarily implanted nitinol device, have expanded the therapeutic armamentarium by reducing invasiveness and better preserving sexual function. However, these methods generally provide less pronounced functional improvement and may be associated with higher retreatment rates.

Conclusion. Current surgical treatment for benign prostatic hyperplasia is based on personalized selection according to prostate size and anatomy, symptom severity, comorbidities, and patient preferences. Transurethral resection of the prostate remains a key clinical benchmark; laser enucleation offers comparable efficacy with lower invasiveness, and ultra-minimally invasive therapies broaden the options for tailored care.

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