Kevin Zorn, MD, on selecting among different MIST options for BPH

In this discussion, recorded at the 2026 American Urological Association Annual Meeting, Kevin C. Zorn, MD, FRCSC, FACS, emphasizes that successful adoption and selection of minimally invasive surgical therapies (MISTs) for benign prostatic hyperplasia (BPH) requires a combination of thoughtful practice integration, careful patient evaluation, and an understanding of the anatomical factors that may influence outcomes. Zorn is the founder/director of BPH Canada in Montreal, Quebec, Canada.

Zorn acknowledged that the rapidly expanding landscape of MIST technologies can be overwhelming for practicing urologists, with new devices, indications, and data emerging regularly. He noted that practical issues such as reimbursement, financial viability, and workflow integration often influence whether a technology can be successfully incorporated into a practice. He suggested that urologists first evaluate which therapies fit their patient population and practice structure. For practices that regularly manage BPH, offering 1 or 2 minimally invasive alternatives may provide patients with options that emphasize faster recovery, reduced catheterization time, and less invasive treatment approaches. Zorn also encouraged clinicians interested in adopting new technologies to seek mentorship and training from experienced users to better understand patient selection and procedural implementation.

Zorn also emphasizes the importance of a comprehensive preoperative evaluation. He stressed that patient selection should be guided by objective anatomical assessment rather than prostate volume alone. While measuring prostate size has become standard practice following guideline recommendations, Zorn argued that prostate urethral length is an equally important parameter that many urologists still overlook. He explained that urethral length measurements, obtained through ultrasound or cystoscopic assessment, can help determine whether specific stents, balloons, or other implant-based therapies are appropriate, as device sizing and effectiveness often depend on the dimensions of the prostatic urethra.

Zorn further highlighted the value of cystoscopic evaluation to identify anatomical features that may affect treatment success, including obstructive median lobes, elevated bladder necks, and other structural factors that may not be addressed by every MIST technology. Understanding these nuances allows clinicians to match the right intervention to the right patient rather than applying a one-size-fits-all approach.