{"id":315849,"date":"2025-09-02T10:05:13","date_gmt":"2025-09-02T10:05:13","guid":{"rendered":"https:\/\/www.pierluigibove.com\/2025\/09\/02\/prof-bove-discusses-minimally-invasive-techniques-for-benign-prostatic-hyperplasia-precision-personalization-and-clinical-common-sense\/"},"modified":"2026-01-13T11:47:54","modified_gmt":"2026-01-13T11:47:54","slug":"prof-bove-discusses-minimally-invasive-techniques-for-benign-prostatic-hyperplasia-precision-personalization-and-clinical-common-sense","status":"publish","type":"post","link":"https:\/\/www.pierluigibove.com\/en\/2025\/09\/02\/prof-bove-discusses-minimally-invasive-techniques-for-benign-prostatic-hyperplasia-precision-personalization-and-clinical-common-sense\/","title":{"rendered":"Prof. Bove discusses minimally invasive techniques for benign prostatic hyperplasia: precision, personalization, and clinical common sense"},"content":{"rendered":"\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-4e90518624c9631a9fe11585cda7c170 wp-block-paragraph\">Prof. Bove discusses minimally invasive techniques for benign prostatic hyperplasia: precision, personalization, and clinical common sense<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">A common condition, and an answer that must be tailored.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\"><strong>Benign prostatic hyperplasia (BPH)<\/strong> is one of the most common conditions in men after the age of fifty. It involves a non-cancerous enlargement of the prostate gland, with urinary symptoms that can significantly affect quality of life. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">In recent years, advances in urologic surgery have made increasingly less invasive techniques available, with the aim of reducing hospital stay, lowering the risk of complications, and limiting side effects affecting sexual function. Among these, the so-called <strong>MIST\u2014Minimally Invasive Surgical Techniques<\/strong>\u2014are among the most discussed and requested options. But precisely for that reason, it is essential to avoid generalizations.  <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cThere is no single technique that is right for everyone,\u201d says Professor Pierluigi Bove, urologist, Associate Professor of Urology at the University of Rome Tor Vergata and Head of U.R.M.I. \u2013 Robotic and Minimally Invasive Urology at Policlinico Tor Vergata. \u201cEvery patient is different and deserves a personalized approach, not a standardized solution.\u201d <\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-092bea012fff2808a67adad65712cfb9 wp-block-paragraph\">What MIST are<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Minimally invasive techniques for BPH are based on the idea of removing or <strong>reducing obstructive prostatic tissue<\/strong> using less aggressive tools than traditional surgery. Some techniques, such as <strong>Rez\u016bm,<\/strong> use water vapor to create localized necrosis within the prostate; others, such as <strong>UroLift<\/strong>, implant small devices to mechanically widen the urinary channel; others rely on laser technologies or water-based ablation (Aquablation). <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">The benefits most commonly associated with MIST include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li style=\"font-size:16px\">shorter operative times,<\/li>\n\n\n\n<li style=\"font-size:16px\">a lower risk of retrograde ejaculation,<\/li>\n\n\n\n<li style=\"font-size:16px\">the possibility of outpatient treatment (for some of them).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">But it would be a mistake to assume they are always the best choice.<\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-952a7bcee746521207d51a19c973195b wp-block-paragraph\">The importance of a complete clinical assessment<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">The choice of treatment for BPH should never be driven by trends or by what is promoted too lightly in the media. The risk is that poorly informed patients request inappropriate procedures, based on generalized promises or standardized protocols that <strong>do not consider the specific features of an individual case.<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cFor medicine to be effective, it must be precise. And when surgery is done well, it is always personalized,\u201d Professor Bove emphasizes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">A thorough clinical assessment should consider at least:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li style=\"font-size:16px\"><strong>prostate volume,<\/strong><\/li>\n\n\n\n<li style=\"font-size:16px\"><strong>prostate morphology<\/strong> (how it grows and where it exerts pressure),<\/li>\n\n\n\n<li style=\"font-size:16px\"><strong>the patient\u2019s age,<\/strong><\/li>\n\n\n\n<li style=\"font-size:16px\">any <strong>associated conditions,<\/strong><\/li>\n\n\n\n<li style=\"font-size:16px\">and\u2014last but not least\u2014the <strong>patient\u2019s expectations.<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"631\" src=\"https:\/\/www.pierluigibove.com\/wp-content\/uploads\/2025\/09\/Pierluigi-Bove-Urologist-Blog-Post-Prof.-Bove-discusses-minimally-invasive-techniques-for-benign-prostatic-hyperplasia-featured-2-1024x631.jpg\" alt=\"\" class=\"wp-image-315868\" srcset=\"https:\/\/www.pierluigibove.com\/wp-content\/uploads\/2025\/09\/Pierluigi-Bove-Urologist-Blog-Post-Prof.-Bove-discusses-minimally-invasive-techniques-for-benign-prostatic-hyperplasia-featured-2-980x604.jpg 980w, https:\/\/www.pierluigibove.com\/wp-content\/uploads\/2025\/09\/Pierluigi-Bove-Urologist-Blog-Post-Prof.-Bove-discusses-minimally-invasive-techniques-for-benign-prostatic-hyperplasia-featured-2-480x296.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) and (max-width: 980px) 980px, (min-width: 981px) 1024px, 100vw\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\"><\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-72ce08dd80a944f55085b2ee584f5db0 wp-block-paragraph\">Not all techniques are suitable for everyone<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">One of the most underestimated risks of indiscriminate adoption of MIST is <strong>failing to achieve the expected results<\/strong>\u2014or worse, <strong>creating dissatisfaction<\/strong> in patients who were not ideal candidates.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">For example:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li style=\"font-size:16px\">Rez\u016bm works well in <strong>smaller prostates<\/strong> with predominantly central growth;<\/li>\n\n\n\n<li style=\"font-size:16px\">UroLift <strong>is not indicated<\/strong> when there is a large median lobe;<\/li>\n\n\n\n<li style=\"font-size:16px\">some techniques can lead to prolonged bleeding episodes if applied to very large prostates;<\/li>\n\n\n\n<li style=\"font-size:16px\">others, while preserving ejaculation, <strong>may not be effective in fully resolving<\/strong> <strong>obstructive symptoms.<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cThere are patients who are highly motivated to preserve ejaculation, but if the prostate is too large, they need to know that the results of a minimally invasive technique will likely be disappointing,\u201d Prof. Bove explains. \u201cThe truth has to be said beforehand, not managed afterward.\u201d <\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-db585c021d240f316df017efcf0b2f9b wp-block-paragraph\">When technology is not enough: the value of clinical intelligence<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">In an era where there is a tendency to reduce everything to automatic protocols and quick fixes, one simple but crucial principle must be reaffirmed: <strong>no algorithm can replace clinical sensitivity<\/strong> and a <strong>physician\u2019s experience.<\/strong> Even in the most straightforward cases, <strong>a deep understanding of the patient<\/strong>\u2014their history, anxieties, and life goals\u2014plays a decisive role in choosing the right intervention. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cExperience is needed, the ability to \u2018read\u2019 the patient is needed, understanding their psychology is needed\u2014and above all, comprehensive surgery that truly knows all the options,\u201d Prof. Bove reiterates.<\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-ce4139e9354c772bc34629f1a0d7c310 wp-block-paragraph\">The risk of MIST overuse by less experienced operators<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">One of the most concrete concerns in today\u2019s debate about MIST is <strong>excessive or inappropriate use by professionals with limited surgical training.<\/strong> Some techniques, such as Rez\u016bm, are <strong>relatively easy to learn<\/strong> from a technical standpoint, but <strong>that does not mean they are easy to apply correctly to every patient.<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">The result? Procedures proposed as \u201cstandard\u201d even to those who do not have the clinical characteristics to truly benefit, with inevitable cases of dissatisfaction or persistent postoperative symptoms. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Professor Bove addresses this risk firmly:<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cThe fact that a technique is simple to perform does not justify indiscriminate use. Clinical common sense and surgical competence must always guide the decision.\u201d<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">An experienced operator, on the other hand, can <strong>evaluate true compatibility between patient and technique,<\/strong> and propose only procedures that have a solid clinical basis for achieving good outcomes.<\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-5b0102faa4e64f62eca7b67341a5dbdb wp-block-paragraph\">Alternatives: laser, enucleation, and tailored surgery<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Beyond MIST, there are <strong>several other modern techniques<\/strong> that may be more effective in complex settings or in very large prostates.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Among the most established options are:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li style=\"font-size:16px\"><strong>Holmium or Thulium laser: <\/strong>allow vaporization or enucleation of prostatic tissue with excellent results even in large prostates, though with a higher risk of retrograde ejaculation.<\/li>\n\n\n\n<li style=\"font-size:16px\"><strong>Endoscopic enucleation techniques:<\/strong> now represent the standard of care for many patients, thanks to their effectiveness, durability, and safety\u2014especially in experienced hands.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">The goal is not to \u201cdemonize\u201d or \u201csanctify\u201d any technique, but to <strong>bring the discussion back to a serious, clinical, competent level.<\/strong> Modern prostate surgery should be <strong>a complete toolbox,<\/strong> not a one-size-fits-all screwdriver. <\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-807822dcdcc02e59737b57b0cb1b0f7c wp-block-paragraph\">Informing without creating illusions: the role of communication<\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Many patients approach prostate surgery with <strong>high expectations,<\/strong> often shaped by promotional spots, social media videos, or enthusiastic testimonials. It is the physician\u2019s role to <strong>transform expectations into awareness,<\/strong> by explaining clearly: <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li style=\"font-size:16px\">what the proposed technique can do,<\/li>\n\n\n\n<li style=\"font-size:16px\">what side effects may occur,<\/li>\n\n\n\n<li style=\"font-size:16px\">what results are realistically expected in the short and long term,<\/li>\n\n\n\n<li style=\"font-size:16px\">what alternatives exist.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">Only in this way can <strong>postoperative disappointment be avoided<\/strong>\u2014disappointment that often comes not from a clinical failure, but from a <strong>communication gap<\/strong> between doctor and patient.<\/p>\n\n\n\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color has-medium-font-size wp-elements-379f3960e37f13d4e92cfbe10b77a58d wp-block-paragraph\">The future will not be only about technology <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">The future of prostate surgery will certainly be shaped by further technological innovation: even more precise lasers, AI-supported preoperative planning, 3D simulations, and robotics that becomes increasingly accessible. However, no technology will ever replace <strong>an empathetic doctor\u2013patient relationship,<\/strong> or the <strong>surgeon\u2019s critical ability to choose intelligently and responsibly.<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">\u201cMedicine will never be an algorithm,\u201d Professor Bove says. \u201cAnd good surgery will never be a shortcut.\u201d <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">MIST are an important option in the treatment of BPH, but they are <strong>not a universal solution.<\/strong> Modern medicine\u2014and urologic surgery in particular\u2014must always follow the path of <strong>personalization,<\/strong> <strong>multidisciplinary competence,<\/strong> and <strong>clinical common sense.<\/strong> <\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\">In a world that tends to simplify everything, it is the responsibility of physicians to preserve <strong>complexity where it is needed, <\/strong>to protect patients from wrong choices, and to restore surgery to its most noble role: <strong>treating with precision, awareness, and respect for the person.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link has-background wp-element-button\" href=\"https:\/\/www.pierluigibove.com\/urgenze\/\" style=\"background-color:#10b899\" rel=\"nofollow\">BOOK AN APPOINTMENT<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\" style=\"font-size:16px\"><strong>References:<\/strong><br>benign prostatic hyperplasia, minimally invasive prostate surgery, MIST techniques for BPH, personalized BPH treatment, BPH specialist Rome, Rez\u016bm prostate, UroLift prostate, holmium laser prostate, laser prostate enucleation, prostate volume assessment, prostate morphology, ejaculation preservation in prostate surgery, retrograde ejaculation risks, precision medicine prostate, tailored prostate surgery, day surgery urology Rome, prostate expert Rome, human-centered approach to urologic surgery, Prof. Pierluigi Bove, clinical common sense in urology, personalization in urologic treatments, clinical intelligence in medicine, minimally invasive prostate treatment Rome, alternatives to traditional prostate surgery, prostate health awareness, doctor\u2013patient communication, prostate quality of life, managing BPH in younger patients, laser prostate surgery Rome<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prof. Bove discusses minimally invasive techniques for benign prostatic hyperplasia: precision, personalization, and clinical common sense A common condition, and an answer that must be tailored. Benign prostatic hyperplasia (BPH) is one of the most common conditions in men after the age of fifty. It involves a non-cancerous enlargement of the prostate gland, with urinary [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":315872,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"off","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[58,59,1,60],"tags":[],"class_list":["post-315849","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-mist-minimally-invasive-surgical-techniques","category-prostate","category-uncategorized","category-urology"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v25.1 (Yoast SEO v27.6) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Minimally invasive prostate techniques: Prof. Bove on surgery<\/title>\n<meta name=\"description\" content=\"Prof. Pierluigi Bove explains when minimally invasive prostate techniques are appropriate, focusing on 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