Irreversible Electroporation (IRE) for the Treatment of Lower Urinary Tract Symptoms (LUTS) in Men With Benign Prostatic Hyperplasia (BPH) (RELIEF)

Inclusion Criteria:

1. Male, age ≥50 years.
2. Clinical diagnosis of symptomatic benign prostatic hyperplasia (BPH).
3. International Prostate Symptom Score (IPSS) ≥13 at screening.
4. Peak urinary flow rate (Qmax) ≤12 mL/sec on non-catheterized free flow with voided volume ≥125 mL.
5. Post-void residual (PVR) ≤250 mL.
6. Prostate volume between 30 cc and 80 cc by transrectal ultrasound (TRUS) or Magnetic Resonance Imaging (MRI).
7. Willing and able to comply with all study procedures and follow-up requirements.
8. Able to provide written informed consent.
9. Life expectancy ≥10 years.

Exclusion Criteria:

1. Patients with ≥ Grade Group 2 prostate cancer (≥ Gleason score 7).
2. Patients with Grade Group 1 prostate cancer (Gleason score 6) on active surveillance for less than 1 year.
3. Patients with PSA ≥10 ng/mL or PSA density ≥0.15 ng/mL2.
4. Prior surgical or minimally invasive intervention for BPH (e.g., TURP, Rezūm™, UroLift®, laser therapy).
5. Presence of urethral stricture or bladder neck contracture.
6. Patients with a history of pelvic radiation/irradiation.
7. Patients with compromised renal function (serum creatinine level >1.8 mg/dL or upper-tract disease).
8. Obstructing median lobe intravesical prostatic protrusion (IPP) with >1 cm assessed by TRUS or MRI.
9. Active urinary tract infection, prostatitis, or gross hematuria within 3 months of enrollment.
10. Active need of catheterization.
11. Known or suspected neurogenic bladder or underlying neurologic disease affecting bladder function (e.g., Parkinson's disease, multiple sclerosis, stroke with residual urinary symptoms).
12. History of bladder cancer or other urological malignancy.
13. Implanted electrical devices (e.g., pacemaker, defibrillator, neurostimulator) incompatible with IRE energy delivery.
14. Uncorrected bleeding diathesis or current therapeutic anticoagulation that cannot be safely interrupted.
15. Current use of BPH medications unless on a stable dose for ≥6 weeks (alpha-blockers, anticholinergics, beta-3 adrenergic agonists) or ≥6 months (5-alpha reductase inhibitors, phosphodiesterase type 5 inhibitors) prior to baseline, with no planned changes during study follow-up.
16. Prior rectal or pelvic surgery that may interfere with treatment delivery or evaluation.
17. Desire to preserve future fertility.
18. Severe or uncontrolled comorbidities (e.g., NYHA class III/IV heart failure, uncontrolled diabetes, severe pulmonary disease) that, in the opinion of the investigator, would increase study risk or confound outcomes.
19. Participation in another clinical trial involving an investigational drug or device within 30 days prior to enrollment.
20. Patients who are members of a vulnerable population, such as the cognitively challenged or incarcerated, that could expose them to undue influence, coercion, or inability to provide informed consent.