Akademik Veri Yönetim Sistemi
World Journal of Urology, cilt.43, sa.1, 2025 (SCI-Expanded, Scopus)
Objective: To systematically evaluate the efficacy and safety of minimally invasive surgical treatments (MISTs)—including Aquablation, Rezum, transperineal laser prostate ablation (TPLA), prostatic artery embolization (PAE), UroLift®, and the temporary implantable nitinol device (iTIND)—in patients aged 75 years and older with BPH. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines and EAU standards. Literature searches were performed across PubMed, Scopus, and Web of Science up to July 15, 2025. Studies were included if they reported outcomes for male patients ≥ 75 years undergoing one of the specified MISTs, with a minimum of 50 patients per treatment group. Data extraction and risk of bias assessments were performed independently by two reviewers. Results: Out of 830 initial records, 9 studies involving a total of 1099 patients met inclusion criteria. These included three PAE studies, four on Rezum, and two on UroLift. No eligible studies were found for Aquablation, iTIND, or TPLA. The mean patient age was 79.8 years, with baseline IPSS ranging from 15 to 27. MISTs were associated with significant symptom improvement and acceptable safety profiles. Adverse events were predominantly mild (Grade 1–2), with rates ranging from 10.0 to 39.2% across procedures. Serious complications (Grade ≥ 3) were rare, with an overall incidence of 1.2% for Rezum, 2.1% for PAE, and 2.5% for UroLift. PAE and Rezum demonstrated particularly favorable safety outcomes, with procedure times ranging from 6 to 115 min and variable catheterization durations. Most procedures were feasible under local anesthesia. Conclusion: PAE, Rezum, and UroLift offer effective, less invasive alternatives to conventional surgery, demonstrating favorable safety and efficacy profiles in patients aged 75 and older. Each procedure, which can be performed under local or short-term anesthesia, offers lower perioperative morbidity and shorter hospital stays, providing practical treatment options for older men with multiple comorbidities.