What is the Standard Comparator of Minimally Invasive Surgical Therapies (MIST) for Benign Prostatic Obstruction? Medical Versus Surgical Treatment.

Baboudjian, Michael; Nunzio, Cosimo De; Elterman, Dean; Creta, Massimiliano; Pyrgidis, Nikaolos; Moris, Lisa; Duran, Mesut Berkan; Hashim, Hashim et al. · Eur Urol · 2026

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Abstract

The choice of comparator critically determines the interpretability and clinical relevance of trials evaluating minimally invasive surgical therapies (MISTs), with sham-controlled studies now considered insufficient for guideline integration. Active comparators, particularly pharmacological therapy and conventional surgery, provide the highest level of evidence, enabling a meaningful positioning of MISTs within the therapeutic algorithm of male lower urinary tract symptoms/benign prostatic obstruction.