State-of-the-art in minimally invasive treatments for benign prostatic obstruction

Benign prostatic obstruction (BPO), often caused by benign prostatic hyperplasia (BPH), significantly affects quality of life in aging men. While transurethral resection of the prostate remains a standard surgical treatment, its invasiveness and associated side effects have led to the development of minimally invasive surgical therapies (MIST) as alternatives. This narrative review summarizes current evidence on established and emerging MIST options, including Rezum, iTind, UroLift, CoreTherm, TPLA (transperineal laser ablation), Optilume BPH, and new stent-based, first-line interventional therapies (FITs), such as Zenflow Spring, Butterfly, ProVee System, Urocross, and FloStent. These therapies aim to relieve lower urinary tract symptoms with fewer complications, reduced recovery time, and better preservation of sexual function. Each technique varies in mechanism-thermal, mechanical, or pharmacological-and is suited to specific prostate anatomies and patient profiles. Clinical data support their efficacy in improving International Prostate Symptom Score, peak urinary flow rate, and quality of life scores, with durability ranging from one to five years depending on the modality. Adverse events are generally mild and transient, while rates of ejaculatory and erectile dysfunction remain low across most interventions. FITs offer potential for temporary or long-term decompression with minimal procedural requirements. Overall, MIST broaden the therapeutic landscape for men with symptomatic BPO, particularly those who are unfit or unwilling to undergo conventional surgery. As the field evolves, these interventions contribute to a more personalized, function-preserving approach in BPH management.