Complication rate across the minimally invasive surgical treatments (MISTs): where do we stand? A systematic review of the literature

Luca Lambertini; Alessandro Sandulli; Simone Coco; Daniele Paganelli; Anna Cadenar; Paolo Dell'Oglio; Stefano Puliatti; Fabrizio Di Maida; Antonio Andrea Grosso; Daniele Amparore; Riccardo Bertolo; Riccardo Campi; Riccardo Lombardo; Matteo Ferro; Bernardo Rocco; Gianni Vittori; Alessandro Antonelli; Cosimo De Nunzio; Andrea Minervini; Andrea Mari

doi:10.1038/s41391-024-00900-5

Complication rate across the minimally invasive surgical treatments (MISTs): where do we stand? A systematic review of the literature

Prostate Cancer Prostatic Dis. 2024 Oct 22. doi: 10.1038/s41391-024-00900-5. Online ahead of print.

Authors

Luca Lambertini¹, Alessandro Sandulli¹, Simone Coco¹, Daniele Paganelli¹, Anna Cadenar¹, Paolo Dell'Oglio², Stefano Puliatti³, Fabrizio Di Maida¹, Antonio Andrea Grosso¹, Daniele Amparore⁴, Riccardo Bertolo⁵, Riccardo Campi⁶, Riccardo Lombardo⁷, Matteo Ferro⁸, Bernardo Rocco⁸, Gianni Vittori¹, Alessandro Antonelli⁵, Cosimo De Nunzio⁷, Andrea Minervini¹, Andrea Mari⁹

Affiliations

¹ Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy.
² Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
³ Department of Urology, University of Modena and Reggio Emilia, Modena, Italy.
⁴ University of Turin San Luigi Gonzaga Hospital, Division of Urology, Turin, Italy.
⁵ Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
⁶ Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
⁷ Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
⁸ Unit of Urology, Department of Health Science, University of Milan, ASST Santi Paolo and Carlo, Milan, Italy.
⁹ Oncologic Minimally Invasive Urology and Andrology Unit, Department of Experimental and Clinical Medicine, Careggi Hospital, University of Florence, 50121, Florence, Italy. andrea.mari@unifi.it.

PMID: 39438691
DOI: 10.1038/s41391-024-00900-5

Abstract

Background: Over the past decade, the range of surgical options to benign prostatic obstruction (BPO) has expanded significantly with the advent of minimally invasive surgical therapies (MISTs). Nevertheless, the available evidence in the field is heterogeneous. Efficacy and safety thresholds are yet to be determined.

Objective: To evaluate perioperative and long-term complications after MISTs - including Aquablation, steam injection (Rezūm), Transperineal laser ablation of the prostate (TPLA), implantation of a prostatic urethral lift (PUL) and temporary implantable nitinol device (iTIND) - in patients with lower urinary tract symptoms due to BPO.

Evidence acquisition: A systematic literature search was conducted in January 2024 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy used PICO criteria (Patients, Interventions, Comparisons, Outcomes) [1], focusing specifically on patients with BPH-associated LUTS who underwent MIST or other comparative treatments, aiming to assess both perioperative and long-term safety outcomes. Article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest.

Evidence synthesis: The initial electronic search identified 3660 records, of which 24 ultimately met the inclusion criteria and were included in the analysis. Overall, Aquablation was associated with a higher major complications rate of 14% (IQR 6-22), particularly in the case of patients with prostates <70 ml. PUL showed a higher early postoperative acute urinary retention rate (10.9%, IQR 9.2-12.3%), while 1.4% of patients treated with iTIND experienced major perioperative complications. Urinary tract infections were mostly reported in series assessing TPLA and Rezūm.

Conclusions: The adoption of MISTs for LUTS due to BPH is associated with a varied spectrum of perioperative and long-term complications. Our findings showed an acceptable safety profile with specific complications dependent on the type of MIST performed, highlighting the importance of individualized patient selection and procedure-specific considerations.

Publication types

Review