How to cite: Mehan RD. The Ever-Changing Menu of MIST Therapies: What to Choose in Practice.” Grand Rounds in Urology. October 2025. Accessed Jan 2026. https://grandroundsinurology.com/the-ever-changing-menu-of-mist-therapies-what-to-choose-in-practice/
Summary
Rahul D. Mehan, MD, Founder and CEO, East Valley Urology Center, Mesa, Arizona, reviews the expanding range of minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia and offers a practical framework for selecting the appropriate option in clinical practice. Dr. Mehan describes a “prostate renaissance” driven by patient demand for symptom relief with fewer side effects, faster recovery, and preservation of sexual function, particularly ejaculatory function.
Dr. Mehan explains that many men with bothersome lower urinary tract symptoms remain untreated due to concerns about adverse effects associated with traditional surgery. Survey data presented in the talk highlight that ejaculatory function is a high priority for men across age groups and is frequently under-discussed during preoperative counseling. He emphasizes that sexual function extends beyond erectile function alone and should be incorporated into shared decision-making.
The presentation organizes treatment options into a practical menu that includes MIST procedures, traditional surgical approaches, and adjunctive medical therapy. Dr. Mehan outlines how he evaluates patients in practice, beginning with symptom severity, quality of life, and sexual health assessment, followed by targeted diagnostic testing. Ultrasound, uroflow assessment, and cystoscopy are used to characterize prostate size, anatomy, and bladder health, which directly influence procedure selection.
Each MIST option is reviewed with respect to mechanism, durability, retreatment rates, and impact on ejaculation. Procedures discussed include prostate artery embolization, prostatic urethral lift, water vapor thermal therapy, temporary implantable devices, and drug-coated balloon dilation. Dr. Mehan contrasts these approaches based on prostate anatomy, patient preferences, and tolerance for recovery and risk.
The presentation concludes by emphasizing individualized care through shared medical decision-making. Dr. Mehan encourages aligning patient goals with realistic procedural outcomes to optimize satisfaction while preserving urinary and sexual function.
About The 12th Urology Today Conference:
Presented by chair Ryan P. Terlecki, MD, FACS, the 12th Urology Today conference was designed to keep urologists, urologic oncologists, and other healthcare providers educated on the most pertinent issues in urology practices. Areas of focus included urologic oncology, men’s health and reconstruction, female urology, pediatric urology, kidney stones and related conditions, and methods of providing the best care amidst the required logistics of the business side of medicine.
ABOUT THE AUTHOR
Rahul D. Mehan, MD, is Founder and CEO of East Valley Urology Center in Mesa, Arizona. Dr. Mehan is a nationally-recognized expert in minimally invasive surgery, hormone optimization, and longevity medicine. His skillset spans robotic surgeries for kidney and prostate cancer, focal therapies such as HIFU, NanoKnife and TULSA-PRO, and comprehensive men’s health services including testosterone optimization and vasectomy. Dr. Mehan also specializes in women’s urology—offering advanced treatment for recurrent UTIs, urinary incontinence, and pelvic floor restoration.
Dr. Mehan earned his medical degree from Wright State University Boonshoft in Dayton, Ohio. He then completed his residency in Urology at Indiana University in Indianapolis. Dr. Mehan is an expert in surgical therapies forbenign prostatic hyperplasia (BPH), including GreenLight laser vaporization, Rezum, Urolift, iTInd, and Aquablation. He holds a Center of Excellence Certification for GreenLight, Rezum, and Urolift. Dr. Mehan has been invited to teach surgery throughout the U.S. and led several workshops at the most recent American Urological Association (AUA) national meeting. He was the first to offer Aquablation in the Southwest and has performed one of the largest series of cases in the U.S. Dr. Mehan is the founder of Snip City and has become the go-to surgeon for a vasectomy in the Phoenix area. He has been featured on several TV segments for men’s health and strives to be an influencer on social media.
