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.
European urology. 2026 Jun 12 [Epub ahead of print]
Michael Baboudjian, Cosimo De Nunzio, Dean Elterman, Massimiliano Creta, Nikaolos Pyrgidis, Lisa Moris, Mesut Berkan Duran, Hashim Hashim, Markos Karavitakis, Sachin Malde, Christopher Netsch, Malte Rieken, Vassileios Sakalis, Natasha Schouten, Manuela Tutolo, Thomas Rw Herrmann, Jean-Nicolas Cornu, European Association of Urology (EAU) Guidelines Panel on Management of Non-neurogenic Male LUTS
Department of Urology, North Academic Hospital, Assistance Publique des Hôpitaux de Marseille (AP-HM), Marseille, France. Electronic address: ., Department of Urology, Sapienza University, Ospedale Sant'Andrea, Rome, Italy., Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada., Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy., Department of Urology, University Hospital Munich, Munich, Germany., Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium., Department of Urology, Pamukkale University, Denizli, Turkey., Bristol Urological Institute, Bristol, UK., Department of Urology, Central Urology, Lefkos Stavros Athens Clinic, Athens, Greece., Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK., Department of Urology, Asklepios Klinik Barmbek, Hamburg, Germany., The University of Basel, Basel, Switzerland., Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece., European Association of Urology Guidelines Office, Arnhem, The Netherlands., Department of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy., Department of Urology, Spital Thurgau AG, Kantonsspital Frauenfeld, Frauenfeld, Switzerland; Division of Urology, Department of Surgical Sciences, Stellenbosch University, Western Cape, South Africa; Hannover Medical School, Hannover, Germany., Department of Urology, Hôpital Charles Nicolle, CHU Hôpitaux de Rouen, Rouen, France.