Effective clinical management of benign prostatic obstruction is determined by the ability to address lower urinary tract symptoms as measured via patient-reported outcomes (PROs). Minimally invasive surgical therapies (MISTs) offer better erectile or ejaculatory side effects and potentially faster recovery time in comparison to transurethral resection of the prostate (TURP). Premature excitement for MISTs derives from prospective sham-controlled trials with several years of follow-up data. Currently there is a lack of randomized controlled trials that directly compare MISTs to TURP and of a clearer definition of treatment failure. These types of studies are important in comparing efficacy between treatments. In head-to-head comparison, TURP yields the most robust improvement in PROs when compared to MISTs. At best, MISTs may achieve equivalent urological symptom-relief profiles to TURP; however, noninferiority assessments are needed. MISTs are potentially advantageous for their side-effect profiles and lower complication rates, but consistency in reporting these data is needed. PATIENT SUMMARY: We looked at the current data on patient-reported outcomes after each type of treatment for lower urinary tract symptoms. We found that the efficacy of these procedures is difficult to compare given the lack of direct studies comparing new options to the standard procedure. We can only conclude that the standard procedure, transurethral resection of the prostrate, will provide the best relief of voiding symptoms as reported by patients.
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