# A Narrative Review of New Emerging Urological Interventions for Benign Prostatic Hyperplasia: HoLEP, Rezum, and Aquablation

## TL;DR

This paper reviews new minimally invasive surgeries for enlarged prostate, comparing their effectiveness and safety to traditional methods.

## Contribution

The paper provides a narrative review comparing HoLEP, Rezum, and Aquablation as emerging alternatives to TURP for BPH.

## Key findings

- HoLEP is non-inferior to TURP in outcomes for larger prostates.
- Rezum is effective for outpatient treatment and preserves sexual function.
- Aquablation is suitable for larger prostates and preserves sexual function.

## Abstract

Benign prostatic hyperplasia (BPH) is more prevalent with increasing age, leading to presentations with lower urinary tract symptoms (LUTS). Transurethral resection of the prostate (TURP) remains the gold standard surgical treatment, but its limitations and complications have prompted the development of minimally invasive surgeries. This review evaluates the efficacy and safety of holmium laser enucleation of the prostate (HoLEP), water vapor therapy (Rezum), and robotic water-jet resection (Aquablation) in benign prostate surgery. A narrative review was conducted using PubMed and Google Scholar to identify current literature published between January 2000 and August 2025. Meta-analyses and randomized controlled trials (RCTs) were preferred, but all levels of evidence were considered for this article. Search terms included "benign prostatic hyperplasia", "BPH", "Rezum", "HoLEP", and "Aquablation". These emerging minimally invasive prostate surgeries show promising outcomes and have a role to play, depending on patient choices, surgical expertise, and anatomical factors. HoLEP provides good long-term outcomes and is non-inferior to TURP outcomes in International Prostate Symptom Score (IPSS) and maximum urinary flow rate (Qmax), particularly in larger prostates. Rezum can be performed in an outpatient setting and is effective in preserving sexual function. Aquablation is also effective in preserving sexual function and is suitable for larger prostates. In conclusion, surgical options for managing BPH are evolving technologies that are increasingly replacing the gold standard TURP. More multicenter RCTs comparing all techniques are required to ensure that the data are representative across all populations.