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  • Ari Isaacson, MD

Minimally Invasive Surgical Therapies (MISTs) vs PAE for Enlarged Prostate (BPH)


Minimally invasive surgical therapies or MISTs for BPH are treatments performed in an office setting that do not require general anesthesia or overnight stay. They are performed by a urologist and involve placing an instrument through the penis to treat the prostate. They are desirable by many men because they have a lower risk of complication including sexual side-effects. However, the effects of these procedures are not as dramatic and do not last as long as the gold standard surgery, transurethral resection of the prostate (TURP) or the “roto-rooter” procedure as it is affectionately known by many men.


The two most popular MISTs are:


· Rezum or Water Vapor Therapy

· Urolift of Pelvic Urethral Lift


Rezum involves placing a small scope into the penis and then the prostate tissue is sprayed with steam. The heat from the steam kills the prostate tissue, which ultimately, is reabsorbed by the body. Symptomatic improvement occurs in about 2 weeks after the procedure and lasts for about 5 years. Possible complications include infection, bleeding, decreased ejaculatory volume, worsening erectile dysfunction, pain with ejaculation, possible need for a catheter after the procedure amongst others. However, it should be known that these complications are rare.






Urolift is also performed with a scope placed in the penis. Bands are placed through the lobes of the prostate and then they are cinched down to compress the prostate tissue away from the center. This opens up the urethra or the tube that carries the urine from the bladder to the penis. Most commonly a Foley catheter is not placed after the procedure. Symptomatic relief tends to be immediate and the effect of the procedure lasts about 5 years. Possible complications include pain, infection, bleeding, urinary leakage and burning with urination.



PAE does not involve any instruments placed through the penis, but rather a small catheter about the width of a piece of spaghetti placed in the artery. The catheter is manipulated into the arteries supplying the prostate using x-ray and contrast dye. The prostate arteries are then blocked using microscopic spheres. Both sides of the prostate are treated through the same puncture site. Most typically no Foley catheter is required. Improvement in urination occurs in about 10-14 days after the procedure and the effect most typically lasts 5-7 years. Possible complications include bleeding, infection, reduced ejaculatory volume, urinary retention and extremely rarely, skin ulceration.



All in all, MISTs and PAE result in a similar degree of improvement in urination, a similar duration of improvement and have similar side effects. One main difference, however, is the size of the prostate that can be treated. MISTs are recommended for prostates up to 80ml in volume while PAE has no maximum limit. In fact, data shows that the larger the prostate, the better the outcome after PAE. Also PAE can be performed without stopping blood thinning medication and without sedation if needed, based on the individual situation.

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