Defining minimal invasive surgical therapy for benign prostatic obstruction surgery: Perspectives from a global knowledge, attitudes, and practices survey

Objective To scrutinize the definitions of minimal invasive surgical therapy (MIST) and to investigate urologists’ knowledge, attitude, and practices for benign prostatic obstruction surgeries. Methods A 36-item survey was developed with a Delphi method. Questions on definitions of MIST and attitude and practices of benign prostatic obstruction surgeries were included. Urologists were invited globally to complete the online survey. Consensus was achieved when 70% responses were “agree or strongly agree” and ≤15% responses were “disagree or strongly disagree” (consensus agree), or when 70% responses were “disagree or strongly disagree” and ≤15% responses were “agree or strongly agree” (consensus disagree). Results The top three qualities for defining MIST were minimal blood loss (n=466, 80.3%), fast post-operative recovery (n=431, 74.3%), and short hospital stay (n=425, 73.3%). The top three surgeries that were regarded as MIST were Urolift® (n=361, 62.2%), Rezum® (n=351, 60.5%), and endoscopic enucleation of prostate (EEP) (n=332, 57.2%). Consensus in the knowledge section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of prostate with regards to blood loss, recovery, day surgery feasibility, and post-operative continence. Consensus in the attitudes section was achieved for the superiority of Urolift®, Rezum®, and iTIND® over transurethral resection of prostate with regards to blood loss, recovery, and day surgery feasibility. Consensus on both sections was achieved for EEP as the option with the best symptoms and flow improvement, low retreatment rate, and best suitable for prostate >80mL. Conclusion Minimal blood loss, fast post-operative recovery, and short hospital stay were the most important qualities for defining MIST. Urolift®, Rezum®, and EEP were regarded as MIST by most urologists.