Next-gen minimally invasive surgical therapies for benign prostatic hyperplasia: innovations, selection, and best practices- a review from European Association of Urology endourology.

The expanding range of minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia (BPH) reflects a growing emphasis on individualized, anatomy-driven treatment that prioritizes symptom relief, reduced morbidity, and preservation of sexual function. This review provides a timely synthesis of MISTs, highlighting innovations in technique, key anatomical considerations, and evolving strategies for patient-centered care in the modern clinical setting. Recent studies highlight the expanding role of MISTs, such as UroLift, Rezūm, the temporary implanted nitinol device, Optilume BPH, transperineal laser ablation, and prostatic stents. Each modality shows distinct performance characteristics depending on factors such as prostate volume, intravesical prostatic protrusion, bladder neck configuration, and the presence of a median lobe. Increasing attention has also been given to preserving antegrade ejaculation, which is often a high priority for younger or sexually active patients. Concurrently, new decision aid tools are in development to support shared decision-making in concordance with patient values and treatment preferences. MISTs represent a diverse and maturing set of therapeutic options. Optimizing their use requires detailed anatomical assessment and thoughtful, individualized decision-making to align treatment with patient goals, preserve function, minimize morbidity, and reflect contemporary evidence-based standards in BPH management.