The new kids on the block: prostatic urethral lift (Urolift) and convective water vapor energy ablation (Rezūm).
The main objective of novel minimally invasive treatment options is to provide relief of bothersome lower urinary tract symptoms (LUTS) equally effective to current standard techniques, but with a more favorable safety profile. Here we present the first clinical experience with the prostatic urethral lift (Urolift) and the convective water vapor energy ablation (Rezūm). Urolift offers rapid and durable relief of LUTS with complete preservation of sexual function. It is not as effective as the reference method transurethral resection of the prostate (TURP) in terms of symptom relief and urodynamic parameters, but it in selected patients with special interest in sexual activity and rapid recovery it may be an attractive option. The Rezūm system also offers rapid and safe relief of LUTS without compromising sexual function. But it targets all critical prostatic zones including an obstructive middle lobe. In selected patients with bothersome LUTS, who seek a minimally invasive procedure offering a fast return to daily activity and complete preservation of sexual function, Urolift is a good option. First 3-year clinical data on Rezūm demonstrated efficacy and safety in a prospective randomized, sham-controlled trial. It addresses all critical zones of benign prostatic obstruction including the middle lobe without compromising sexual function. Long-term data and the direct comparison with the reference method TURP are missing to define its role in the surgical spectrum of minimally invasive treatment options.