AUA 2026: Updates on Management of Benign Prostatic Hyperplasia

Comparative Risk of Erectile and Ejaculatory Dysfunction Following UroLift vs. Optilume in Men Undergoing Minimally Invasive BPH Therapy: A Propensity-Matched Cohort Study of 12-Month Outcomes

Authors: Muhammed A. Moukhtar Hammad, Bradley Roth, Elia Abou Chawareb, Eliad Amini, Mohammed Mahdi, Akhil Das, and Faysal A. Yafi

This retrospective cohort study compared sexual outcomes following two minimally invasive surgical therapies for benign prostatic hyperplasia (BPH): UroLift and Optilume. Using the TriNetX Research Network, patients with prior erectile dysfunction (ED) or ejaculatory dysfunction (EJD) were excluded. After propensity matching, 1,169 patients were included in each treatment group. Among patients without baseline ED, new-onset ED within 12 months occurred in 6.76% of UroLift patients and 2.78% of Optilume patients. Optilume was associated with a significantly lower risk of ED (RR 0.412; 95% CI 0.259–0.655; p=0.0001). However, Kaplan–Meier survival analysis showed no significant difference in 12-month ED-free survival between groups.

New-onset EJD was rare in both groups, occurring in 10 or fewer patients per group, with no significant difference in risk or EJD-free survival between UroLift and Optilume.

Overall, both procedures demonstrated low rates of sexual dysfunction at 12 months. Optilume may be preferred in patients considered at higher baseline risk for erectile dysfunction.

A Randomized, Placebo-Controlled Trial Evaluating Tadalafil 5 mg for Management of Early Storage Symptoms and Erectile Dysfunction After HoLEP

Authors: Mohammed M. Aljabiri, Nasr El-tabey, Ahmed Shehab-El-Din, and Mahmoud Laymon

This prospective randomized placebo-controlled trial evaluated whether tadalafil 5 mg daily, started on the day of holmium laser enucleation of the prostate (HoLEP), improves early postoperative sexual function and storage urinary symptoms in men with benign prostatic hyperplasia (BPH). A total of 144 patients were randomized to tadalafil or placebo for 3 months following HoLEP. The primary endpoint was orgasmic function assessed using the International Index of Erectile Function-15 (IIEF-15). At 1 month, tadalafil significantly improved overall sexual function compared with placebo, including erectile function and orgasmic function. Improvement in orgasmic function remained significant at 3 months (AMD +2.3; 95% CI +1.4 to +3.2; p<0.001), but differences between groups were no longer evident at 6 months after stopping therapy.

Urinary outcomes improved in both groups after HoLEP, but tadalafil showed additional early benefits in International Prostate Symptom Score (IPSS) total score, storage symptoms, and quality of life at 2 weeks, 1 month, and 3 months. These benefits also diminished by 6 months. Adverse events with tadalafil were infrequent and included headache, musculoskeletal pain, and dyspepsia. Thirty-day complication rates were similar between groups.

Overall, short-term tadalafil therapy after HoLEP provided clinically meaningful early improvements in sexual function and storage urinary symptoms during the postoperative recovery period.

Perioperative Outcomes and Prevalence of Urethral Strictures During Surgery for Benign Prostatic Hyperplasia: Results from the GRAND Study

Authors: Nikolaos Pyrgidis, Gerald Bastian Schulz, Philipp Weinhold, Yannic Volz, Iason Papadopoulos, Christian Stief, Julian Marcon, and Patrick Keller

This registry-based study evaluated the prevalence and perioperative outcomes of urethral strictures in patients undergoing surgery for benign prostatic hyperplasia (BPH) in Germany between 2005 and 2022. Among 1,367,065 BPH surgeries, 150,356 patients (11%) had a concomitant urethral stricture. The median age was 72 years. Management of urethral strictures included internal urethrotomy in 75% of cases, urethral dilation in 20%, and meatoplasty in 5%.

The annual prevalence of urethral strictures during BPH surgery decreased over time, from 7.5% in 2005 to 3.9% in 2022. Compared with patients without urethral strictures, those with strictures had higher rates of postoperative incontinence (4.5% vs 3.6%) and reoperations (1.2% vs 0.8%). However, perioperative acute urinary retention was slightly lower in patients with urethral strictures (9.3% vs 9.8%).

Overall, urethral strictures were relatively common during BPH surgery and were associated with differences in perioperative outcomes.

Three-Year Reintervention Outcomes After Rezum vs UroLift: A TriNetX Comparative Analysis

Authors: Pin Chun Chen, Yu-Cheng Lu, Allen W. Chiu, Chen‑Hsun Ho, Chih-Wei Wu, and Yu-Hsuan Shao

This real-world study compared 3-year reintervention rates following Rezum and UroLift procedures for benign prostatic hyperplasia (BPH). Using the TriNetX US Collaborative Network, 3,231 men aged ≥40 years who underwent Rezum or UroLift between 2018 and 2020 were identified. After propensity score matching, overall reintervention risk was similar between the two procedures (Hazard Ratio (HR) 1.19; 95% Confidence Interval (CI) 0.82–1.73). Among patients aged ≥65 years, Rezum was associated with a significantly lower reintervention rate compared with UroLift (HR 0.60; 95% CI 0.37–0.97). In patients aged 40–64 years, reintervention rates were comparable between treatments.

Within the Rezum group, younger patients had a higher risk of reintervention than older patients (HR 2.12; 95% CI 1.15–3.93). No age-related difference was observed in the UroLift group.

Overall, the findings suggest that patient age may influence the long-term durability of minimally invasive BPH treatments.

The MILES Trial: Prospective Randomized Trial of Safety and Efficacy of Minimally Invasive Versus Standard Laser Enucleation of the Prostate

Authors: Vladislav Petov, Camilla Azilgareeva, Andrey Bazarkin, Alim Dymov, Yulia Li, Temirlan Karakotov, Roman Sukhanov, Leonid Chuvalov, Mikhail Enikeev, Magomed Gazimiev, Leonid Rapoport, and Felipe Figueiredo

This prospective randomized trial compared minimally invasive laser enucleation of the prostate (MiLEP) with standard endoscopic enucleation of the prostate (EEP) for benign prostatic hyperplasia (BPH). A total of 155 patients were randomized to MiLEP using a smaller 22 Ch resectoscope or standard EEP using a 26 Ch resectoscope. Baseline characteristics were similar between groups. Operative time, enucleation efficiency, morcellation efficiency, catheterization duration, hospital stay, and tissue removal were comparable between the two procedures. Both groups showed significant improvement in urinary symptoms and flow rates, with no significant differences in functional outcomes. Stress urinary incontinence (SUI) after catheter removal was significantly lower with MiLEP compared with standard EEP (6.5% vs 29.5%; p=0.04). At 3 months, continence rates were 100% with MiLEP and 87.2% with standard EEP.

Rates of urethral stricture at 3 months were numerically lower with MiLEP (1.3% vs 6.4%), although the difference was not statistically significant. Minor complication rates were similar between groups.

Overall, MiLEP demonstrated similar efficacy to standard EEP with lower rates of early postoperative stress urinary incontinence.

Medical Treatment of Benign Prostatic Hyperplasia After Bladder Outlet Procedures

Authors: Mahir Maruf, Andrew Gabrielson, Chloe Michel, and Naren Nimmagadda

This TriNetX database study evaluated the need for restarting benign prostatic hyperplasia (BPH) medications after different outlet procedures. The study included men undergoing laser enucleation of the prostate (LEP), transurethral resection of the prostate (TURP), photoselective vaporization of the prostate (PVP), prostatic urethral lift (PUL), transurethral water vapor thermal therapy (WVTT), or Aquablation between 2005 and 2025. The primary outcome was initiation of alpha-blockers or 5-alpha reductase inhibitors (5ARIs) at least 3 months after surgery.

The median time to new alpha-blocker therapy was not reached in the LEP and Aquablation groups, compared with 7.1 years for TURP, 7.9 years for PVP, 3.7 years for PUL, and 3.4 years for WVTT. At 5 years, the probability of requiring new alpha-blocker therapy was 28% for LEP, 43% for TURP, 40% for PVP, 58% for PUL, 57% for WVTT, and 27% for Aquablation.

Overall, LEP was associated with lower rates of restarting alpha-blocker therapy compared with TURP, PVP, PUL, and WVTT, with rates similar to Aquablation.

Reintervention Rates and Patterns of Reoperation Following Surgical Management of Benign Prostatic Hyperplasia

Authors: Sahil H. Patel, Alka Tomar, Qiuchen Li, and Smita De

This retrospective TriNetX study evaluated reintervention rates following different surgical procedures for benign prostatic hyperplasia (BPH) and assessed patterns of secondary procedures for recurrent disease. The analysis included over 112,000 patients with at least 1 year of follow-up, 81,554 with 3-year follow-up, and 52,426 with 5-year follow-up. Simple prostatectomy and laser enucleation of the prostate (LEP) had the lowest reoperation rates, ranging from 0.9–1.4% and 1.5–6.0%, respectively. Less invasive procedures showed higher reoperation rates, including water vapor thermal therapy (WVTT; 5.3–14.8%), prostatic urethral lift (PUL; 4.3–16.6%), and transurethral needle ablation (TUNA; 5.8–21.0%).

Among patients requiring repeat procedures after at least 5 years of follow-up, transurethral resection of the prostate (TURP) was the most common secondary procedure (61%), followed by photoselective vaporization of the prostate (PVP; 22%) and LEP (8%).

Overall, LEP demonstrated low retreatment risk comparable to simple prostatectomy, while less invasive therapies were associated with higher reoperation rates and often required more invasive secondary interventions.

Comparative Outcomes of Holmium Laser Enucleation (HoLEP), Prostatic Urethral Lift (UroLift), Rezum, and Transurethral Resection of the Prostate (TURP): A Systematic Review of Evidence from 2015 to 2025

Authors: Waqas Khalil, Muhammad Mazhar Sheikh, and Jawad Islam

A systematic review of 42 studies compared holmium laser enucleation of the prostate (HoLEP), transurethral resection of the prostate (TURP), Rezūm water vapor therapy, and prostatic urethral lift (UroLift) for lower urinary tract symptoms (LUTS) caused by benign prostatic obstruction (BPO). HoLEP showed the greatest symptom improvement, with International Prostate Symptom Score (IPSS) reductions of 18–21 points and the lowest retreatment rate (~6% at 5 years). TURP achieved durable symptom relief with IPSS reductions of 13–15 points and retreatment rates of 7–8% at 5 years. Rezūm provided moderate symptom improvement (IPSS −12 to −14) with 4–5% reoperation at 4 years and minimal sexual dysfunction. UroLift preserved ejaculatory function and enabled faster recovery but showed smaller symptom improvement (IPSS −11) and higher retreatment rates (~13% at 5 years).

On conclusion, across randomized controlled trials, HoLEP and TURP showed similar improvements in IPSS and peak urinary flow rate (Qmax), while HoLEP was associated with less bleeding, shorter catheterization time, and shorter hospital stay.

Efficacy and Safety of Mirabegron and Tamsulosin Combination Therapy Compared to Taumsulosin Monotherapy for Lower Urinary Tract Symptoms due to Benign Prostatic Hyperplasia: Results of Multicenter, Randomized, Double-Blind, Phase III Clinical Trial

Authors: Tae Hyo Kim, Jun Hee Lee, and Lee Ki Soo

This phase 3 randomized, double-blind, placebo-controlled trial evaluated mirabegron plus tamsulosin combination therapy versus tamsulosin monotherapy in men with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). The study was conducted across 25 centers between July 2021 and October 2023. A total of 795 patients were randomized to monotherapy (n=397) or combination therapy (n=398). After 12 weeks, 342 patients in the monotherapy group and 339 patients in the combination therapy group completed the study.

Combination therapy resulted in greater improvements in total urinary frequency score (TUFS) and International Prostate Symptom Score (IPSS) compared with monotherapy. TUFS improved by -11.28 with combination therapy versus -8.30 with monotherapy (p<0.0001), while IPSS improved by -10.85 versus -9.85, respectively (p=0.0325). Combination therapy also showed significantly greater improvement in storage symptoms and voiding diary parameters, including daytime frequency, urgency, and incontinence. Treatment-emergent adverse events were similar between the combination and monotherapy groups (13.10% vs 16.58%; p=0.1943), with no serious drug-related adverse events reported.

Overall, mirabegron plus tamsulosin combination therapy was more effective than tamsulosin alone in improving LUTS in patients with BPH, while maintaining a comparable safety profile.

The LURN SI-10 Questionnaire: A Valid and Clinically Meaningful Tool That Extends the IPSS in LUTS Assessment

Authors: Rodrigo Espana-Navarro, Enrique Gomez-Gomez, Javier De La Torre, Luis Ortega-Polledo, Javier Fernandez-Siles, Daniel Carrasco-Gomez, Emilio Garcia-Galisteo, Borja García-Gómez, Fernando Gómez-Sancha, Eduardo Albers, and Manuel Saavedra Centeno

This multicenter cross-sectional study evaluated the Lower Urinary Tract Dysfunction Research Network Symptom Index-10 (LURN SI-10) in 212 men with lower urinary tract symptoms (LUTS) and assessed its correlation with the International Prostate Symptom Score (IPSS). Median scores were 14 for IPSS and 9 for LURN SI-10. Both tools showed high internal consistency, with Cronbach’s alpha values of 0.85 for IPSS and 0.82 for LURN SI-10. LURN SI-10 showed a strong correlation with IPSS (ρ=0.76, p<0.001) and effectively differentiated symptom severity groups and patients with versus without urinary incontinence (p<0.001).

Receiver operating characteristic analysis demonstrated good diagnostic performance, with an area under the curve (AUC) of 0.86 (95% confidence interval [CI]: 0.81–0.91). A cut-off score of ≥8 provided 72% sensitivity and 87% specificity. Bladder pain (β=0.283, p<0.001), urgency incontinence (β=0.192, p=0.009), and post-micturition dribble (β=0.153, p=0.043) were independently associated with higher IPSS scores.

Overall, LURN SI-10 demonstrated strong reliability and clinical agreement with IPSS while capturing additional symptom domains such as bladder pain and incontinence.

Efficacy and Safety of Vibegron in Men =75 Years of Age with Symptoms of Overactive Bladder on Pharmacotherapy for Benign Prostatic Hyperplasia: A Subgroup Analysis of the COURAGE Trial

Authors: Rodrigo Espana-Navarro, Enrique Gomez-Gomez, Javier De La Torre, Luis Ortega-Polledo, Javier Fernandez-Siles, Daniel Carrasco-Gomez, Emilio Garcia-Galisteo, Borja García-Gómez, Fernando Gómez-Sancha, Eduardo Albers, and Manuel Saavedra Centeno

This subgroup analysis of the phase 3 COURAGE trial evaluated the efficacy and safety of vibegron in men aged ≥75 years with overactive bladder (OAB) symptoms receiving pharmacotherapy for benign prostatic hyperplasia (BPH). Among the 1080 patients included in the efficacy analysis, 192 patients were aged ≥75 years, including 92 who received vibegron and 100 who received placebo. Vibegron treatment resulted in clinically significant reductions in daily micturitions, urgency episodes, and nocturia episodes at weeks 12 and 24 compared with placebo. These improvements were comparable to those observed in men aged <75 years.

In patients aged ≥75 years receiving vibegron, 52.1% experienced at least one treatment-emergent adverse event (TEAE), compared with 43.5% in patients aged <75 years. The most common TEAEs in the ≥75-year subgroup were hypertension (5.2%), hematuria (4.2%), and upper respiratory tract infection (4.2%). Adverse event rates were similar between vibegron and placebo in both age groups.

Overall, vibegron improved OAB symptoms and was well tolerated in older men receiving treatment for BPH.

The Association of Finasteride for Benign Prostatic Hyperplasia with Development of Male Breast Cancer in the United States: A Retrospective Cohort Study of TriNetX Database

Authors: Renil S. Titus, Ansh Bhatia, Archan Khandekar, and Hemendra N. Shah

This retrospective cohort study evaluated the association of 5-α reductase inhibitors (5AI), including finasteride and dutasteride, with male breast cancer (MBC), gynecomastia, and erectile dysfunction (ED) in patients with benign prostatic hyperplasia (BPH) using the TriNetX database. Before propensity score matching (PSM), the study included 637,804 patients in the 5AI group and 2,426,442 patients in the non-5AI group. After PSM, 273,403 patients were included in each cohort, with balanced baseline characteristics (standardized mean difference [SMD] <0.1).

Median follow-up was 2.69 years in the 5AI group and 2.56 years in the non-5AI group. Use of 5AI was not associated with a significantly increased risk of male breast cancer (risk ratio [RR] 1.07; 95% confidence interval [CI]: 0.86–1.32). However, 5AI use was associated with a higher risk of gynecomastia (RR 1.36; 95% CI: 1.28–1.44) and erectile dysfunction (RR 1.07; 95% CI: 1.05–1.09).

Overall, the study did not find an increased risk of male breast cancer associated with 5AI use in patients with BPH.

Does Benign Prostatic Hyperplasia Affect the Risk of Repeat TURBT?

Authors: Nicholas Khoo, Shane Cauley, Clara Goebel, Ben Rubin, Jake Bleau, Mark Plante, Jenna Winebaum, Richard Grunert, Seyed Mohammad Mohaghegh Poor, and Brian Irwin

This retrospective TriNetX study evaluated whether benign prostatic hyperplasia (BPH) affects the risk of repeat transurethral bladder tumor resection (TURBT) in men with non-muscle invasive bladder cancer (NMIBC). The analysis included 7,927 men without BPH and 7,869 men with BPH at the time of initial TURBT. Mean age was 67.8 years in the non-BPH group and 72.9 years in the BPH group. Among patients without BPH, the risk of repeat TURBT was 35.7% within 1 year and 43.5% within 5 years. In patients with BPH, repeat TURBT risk increased to 40.2% at 1 year and 51.2% at 5 years. The risk difference between groups was -4.51% (95% confidence interval [CI]: -3.00 to -6.02%) at 1 year and -7.74% (95% CI: -6.12 to -9.30%) at 5 years, showing a significantly lower risk in patients without BPH (p<0.0001).

Overall, untreated BPH was associated with a higher risk of repeat TURBT in patients with NMIBC.

A Randomized Trial Comparing iTind Versus UroLift (MT-08) - Interim Report Findings.

Authors: Bilal Chughtai, Naveen Kella, Neil Barber, Mark Rochester, Joel Abbott, Kalpesh Patel, Louis Krane, Sida Niu, Prithipal Sethi, Adam Stewart, Feras Al-Jafaari, Nilay Gandhi, Tyler McClintock, William Schiff, and Brian Helfand

This ongoing prospective, randomized, controlled multicenter trial compared the Temporarily Implanted Nitinol Device (iTind) with the permanent UroLift System in patients with symptomatic benign prostatic hyperplasia (BPH). By July 2025, 80 patients were enrolled across 15 centers in the United States and United Kingdom, including 46 patients treated with iTind and 34 treated with UroLift. A total of 58 adverse events (AEs) were reported. Adverse events occurred in 32.6% of patients in the iTind group and 47.1% in the UroLift group. Most adverse events in both groups were Clavien-Dindo grade I or II and included urinary retention, hematuria, and dysuria. All events were mild, transient, and expected.

In the iTind group, most adverse events occurred during implantation or retrieval. During the 3 months after retrieval, adverse events occurred in 13% of iTind patients compared with 35% of UroLift patients after implantation. In terms of efficacy, iTind demonstrated statistically significant non-inferiority to UroLift for improvement in International Prostate Symptom Score (IPSS) at 3 months. Mean IPSS improvement was 9.98 with iTind and 11.59 with UroLift. Sexual function was preserved with both treatments.

Overall, preliminary findings support the safety and efficacy of iTind, with fewer post-procedure adverse events after device retrieval.

Predictors of Overactive Bladder Recovery After Robot-Assisted Simple Prostatectomy: Insights from a Prospective Single-Center Cohort

Authors: Alfredo Bove, Rocco Simone Flammia, Aldo Brassetti, Umberto Anceschi, Gabriele Tuderti, Maria Consiglia Ferriero, Riccardo Mastroianni, Simone D'Annunzio, Flavia Proietti, Leonardo Misuraca, Costantino Leonardo, and Giuseppe Simone

This prospective study evaluated predictors of overactive bladder (OAB) recovery after robot-assisted simple prostatectomy (RASP) in men with benign prostatic hyperplasia (BPH) and prostate volume >80 mL. A total of 93 patients were included, and 69 patients (74%) achieved postoperative OAB recovery. Recovery was defined by improvement in Overactive Bladder Questionnaire-Short Form (OABq-SF), no need for postoperative medication for urgency urinary incontinence, and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) score <6.

Age, obesity, prostate volume, surgical technique, and hospital stay were not associated with OAB recovery. However, patients with American Society of Anesthesiologists (ASA) score ≥3 were significantly less likely to recover compared with those with lower ASA scores (9% vs 29%; p=0.03). Univariable analysis showed that ASA score ≥3 independently predicted failure of OAB recovery (odds ratio [OR] 0.23; 95% confidence interval [CI]: 0.07–0.78; p=0.02).

Overall, approximately three-quarters of patients experienced improvement or resolution of OAB symptoms after RASP, while higher ASA scores were associated with poorer recovery outcomes.

Urinary Outcomes of International Prostate Symptom Score Phenotypes Following Transurethral Resection of the Prostate: A Secondary Analysis of the Prostate Cancer Prevention Trial

Authors: Connor Chestnut, Owen Phelps, Sarah K. Holt, Jeannette M. Schenk, and John L. Gore

This study evaluated whether pre-operative International Prostate Symptom Score (IPSS) components could predict symptom improvement after transurethral resection of the prostate (TURP) in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS). Among 103 patients who underwent TURP, 64% achieved improvement in total symptoms and 57% showed improvement in storage symptoms (SS) at 1 year.

Patients with both significant voiding symptoms (VS) and significant SS before surgery had the highest rates of improvement, with 88% showing improvement in both total symptoms and SS. In patients with significant VS but minimal SS, 83% improved in total symptoms and 50% improved in SS. In contrast, patients with significant SS but minimal VS had lower improvement rates, with 44% improving in total symptoms and 41% in SS. Patients with minimal VS and SS had the lowest improvement rates, at 42% for total symptoms and 21% for SS. Differences between groups were statistically significant (p<0.01).

Overall, the presence of significant pre-operative voiding symptoms was associated with greater likelihood of symptom improvement after TURP.

AUA 2026, May15 – 18, Washington, DC.