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available at http://pubmed.ncbi.nlm.nih.gov/32065331 Editorial Comment: In a world of new technologies for benign prostatic hyperplasia (BPH), in which studies are driven by the need for regulatory approval as well as ensuing guidelines appeal, it is fair to say that BPH technology articles aren’t at the highest level of scientific intrigue. Essentially a template is formulated by regulatory agencies, in part directed by current mainstream opinion and consulting with experts, and the protocol cake is baked. In the BPH technology world the demand is symptom improvement and an eventual sham/placebo study with 1-year data and analysis of those who remained in the study. It is certainly less rigorous than intent to treat analysis required for medications but, alas, those are the rules. The prostatic urethral lift (PUL) story has been a remarkable success from the get-go with a clever group of founders focused on the needs of regulatory approval and garnering support in the urological community. In addition, laser focus on reimbursement and prescient understanding of how it needed to be crafted have led to PUL being the leading minimally invasive alternative therapy for BPH. Do the data support this status? For this meta-analysis the authors reviewed 768 articles, of which 5 met the selection criteria of having a minimum followup of 2 years. A total of 386 men were evaluated and 322 (83.4%) were followed for at least 2 years. The data suggest that symptoms improved by 10 points and peak flow rate by 3.5 ml per second. These findings are consistent with the MIST (minimally invasive surgical therapy) data reported using various technologies. In this group of men no de novo retrograde ejaculation was reported. Among the evaluable data 13 of 168 men (7.7%) underwent removal of implants for any reason. The challenge in these types of analyses is what happens to those lost to followup? Do they undergo other interventions? To be fair, this is true for all types of MIST studies, where the bar is set lower for data reporting of cases lost to followup. The challenge for us is to better define failure of therapy. Folks often think that treatment failure is defined by whether the patient had to undergo a second MIST intervention and/or surgery. I would argue that if the patient is still on medical therapy or begins medications de novo, that should be considered a treatment failure as well. I can guarantee you the patient would feel that way. Going forward, these types of data should be part of all studies conducted and ultimately evaluated. We should accept no less in helping treat our patients. This is not a PUL issue, but rather a new way to analyze ALL BPH therapies in the future. Steven A. Kaplan, MD Suggested Reading Bechis SK, Otsetov AG, Ge R, Olumi AF: Personalized medicine for the management of benign prostatic hyperplasia. J Urol 2014; 192: 16. Re: 15 Years’ Survey of Safety and Efficacy of Serenoa Repens Extract in Benign Prostatic Hyperplasia Patients with Risk of Progression A. Z. Vinarov, L. G. Spivak, D. V. Platonova, L. M. Rapoport and D. O. Korolev Clinic of Urology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia Urologia 2019; 86: 17e22. doi:10.1177/0391560318772466 Abstract available at http://pubmed.ncbi.nlm.nih.gov/29741118available at http://pubmed.ncbi.nlm.nih.gov/29741118 Editorial Comment: Many of our patients report success with taking plant extract therapies. When asked if they work, my most common answer is that they help the person from who you bought it. BENIGN PROSTATIC HYPERPLASIA 593 Copyright © 2020 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.