The Peri-Operative Care of MIST For Prostate Hyperplasia

William J. HuangTaiwan Speaker Male Infertility: Challenges and Opportunities in AsiaMale infertility contributes to nearly 50% of all infertility cases, with an increasing burden observed across Asia. In parallel, a dramatic decline in birth rates has emerged in several Asian countries—including South Korea, Japan, Taiwan, and Singapore—reaching historically low total fertility rates (TFRs) of under 1.0. While multifactorial in nature, this demographic crisis underscores the urgent need to address all aspects of reproductive health, including the often-overlooked role of male infertility. Epidemiological data reveal significant regional disparities in the prevalence, diagnosis, and treatment of male infertility. Cultural stigma, limited andrology training, fragmented referral systems, and inadequate coverage of assisted reproductive technologies (ART) have impeded timely diagnosis and intervention. Environmental exposures, endocrine-disrupting chemicals, occupational heat, and increased paternal age have all been linked to declining semen quality, as evidenced by longitudinal studies showing decreased sperm concentration and motility in several urban centers across Asia. Current diagnostic tools—including semen analysis, hormone profiling, genetic testing (e.g., Y-chromosome microdeletion, karyotyping), and imaging—enable better etiological categorization. Microsurgical sperm retrieval techniques such as mTESE have provided new hope for patients with non-obstructive azoospermia, while ICSI and sperm cryopreservation have become increasingly utilized where available. Nevertheless, access remains inconsistent, particularly outside metropolitan regions. Recent integration of AI-based systems for semen evaluation, patient triage, and digital counseling offers promising strategies to improve care delivery, especially in under-resourced settings. However, data privacy, regulatory standards, and user trust continue to pose barriers to widespread implementation. Opportunities for systemic improvement include the development of regional male infertility registries, integration of andrology into national reproductive health frameworks, expansion of insurance coverage for fertility services, and public awareness campaigns to destigmatize male infertility. In light of Asia’s fertility decline, repositioning male reproductive health as a public health and demographic priority is essential for sustainable population policy and long-term healthcare planning. The Peri-Operative Care of MIST For Prostate HyperplasiaMinimally invasive surgical therapies (MIST), particularly UroLift and Rezūm, have transformed the treatment landscape for benign prostatic hyperplasia (BPH), offering effective symptom relief with reduced morbidity and preservation of sexual function. However, optimal outcomes depend not only on procedural execution, but also on well-structured peri-operative care protocols encompassing pre-, intra-, and post-operative management. Pre-operative evaluation includes comprehensive assessment of prostate anatomy—especially size, shape, and presence of median lobe—via imaging (TRUS or cystoscopy) to determine candidacy. Careful patient selection is essential: UroLift is typically suited for prostates <80 cc without obstructive median lobes, while Rezūm accommodates broader anatomical variability but may have delayed symptom resolution. Baseline symptom scores (e.g., IPSS), uroflowmetry, and post-void residual volume establish functional benchmarks and guide patient counseling. Anesthesia planning must consider procedural setting and patient comorbidities. UroLift can often be performed under local anesthesia with light sedation, whereas Rezūm may require short general anesthesia or deeper sedation due to thermal discomfort. Appropriate selection reduces intraoperative stress and facilitates same-day discharge. Intraoperative care focuses on minimizing trauma and ensuring device precision. UroLift requires accurate deployment of implants to maintain lateral lobe retraction without compromising sphincter integrity. In Rezūm, the number and duration of vapor injections must be titrated based on lobe size and configuration to balance efficacy and tissue inflammation. Real-time visualization and standardized protocols reduce variability and improve safety. Post-operative management involves anticipating and controlling transient irritative symptoms, such as dysuria, urgency, and hematuria. Alpha-blockers and anti-inflammatory medications are commonly used for 3–7 days post-procedure. Catheterization strategies differ by technique: UroLift may avoid catheter use entirely, whereas Rezūm often requires 7-14 days of catheter drainage due to anticipated edema. Monitoring for urinary retention, UTI, or clot obstruction is critical during the early recovery phase. Follow-up care typically occurs at 2–4 weeks and includes reassessment of voiding function, symptom scores, and patient satisfaction. Reinforcement of realistic expectations is especially important with Rezūm, which may take 4–6 weeks to achieve peak efficacy. Longitudinal studies indicate sustained symptom relief and low retreatment rates when peri-operative care is standardized and patient education is emphasized. Adverse event profiles differ between techniques: UroLift is associated with less dysuria but higher retreatment rates in large prostates, while Rezūm presents higher rates of transient discomfort but favorable durability. Structured peri-operative care pathways—including patient education, standardized medication protocols, and clear complication management plans—enhance recovery, minimize adverse events, and improve overall clinical success.