Decision-Making for BPH in the MISTs Era

In this video, C. Shawn West, MD, a urologist at McIver Urological Clinic in Jacksonville, Florida, discusses the nuanced process of selecting appropriate candidates for minimally invasive benign prostatic hyperplasia (BPH) therapies. He emphasizes the importance of prostate size, anatomy, and patient goals, noting that therapies such as prostatic urethral lift (UroLift) can be effective across a broad range of gland sizes, including select larger prostates, with appropriate counseling regarding retreatment risk.

A key focus is the preservation of sexual function, which West identifies as a major priority for many patients. He highlights that among available therapies, certain minimally invasive approaches demonstrate strong evidence for maintaining erectile and ejaculatory function, which significantly influences treatment selection and patient satisfaction.

West also underscores the critical role of the International Prostate Symptom Score (IPSS) in clinical workflow, describing it as a “vital sign” in urologic practice. Routine use of IPSS facilitates early identification of symptomatic patients, supports timely intervention, and helps prevent long-term bladder dysfunction. He advocates for proactive evaluation, including cystoscopy and volumetric assessment, to guide shared decision-making and optimize outcomes.