A Comprehensive Review of Minimally Invasive Surgical Therapies for Voiding Dysfunction in Benign Prostatic Hyperplasia: Past Failures, Contemporary Successes and Future Innovations.

PURPOSE OF REVIEW: Treatments for voiding dysfunction secondary to benign prostatic hyperplasia (BPH) have evolved greatly but also attempted to recapitulate existing ideas. This review will detail the MISTs for BPH through three temporal lenses: past failures and their lessons, contemporary therapies with evidence bases and emerging technologies that are potential futures for minimally invasive BPH treatment.

RECENT FINDINGS: Newer minimally invasive surgical therapies (MISTs) either occupy a new technological niche or refine concepts used by earlier, unsuccessful BPH treatments. Historical permanent stents, balloon dilation, prostatic injection therapies, transurethral needle ablation, and transurethral microwave thermotherapy were limited by complications, inconsistent objective improvement, or high retreatment rates. Contemporary options, including prostatic urethral lift, water-vapor thermal therapy, and drug-coated balloon dilation, demonstrate improved symptom and flow outcomes in selected patients, while temporary nitinol devices and histotripsy continue to evolve. Contemporary devices frequently revisit earlier mechanical, thermal, or dilation-based approaches. Improved materials and delivery systems may reduce prior limitations, but they do not eliminate the need to demonstrate durable efficacy, acceptable retreatment rates, preservation of sexual function, and appropriate patient selection through high-quality long-term studies.