Lower urinary tract symptoms (LUTS) secondary to benign prostate obstruction (BPO) afflict a very large part of the population on a global scale. Urologists confront patients with a diversity of BPH-related symptoms in their daily practice. For years, the cornerstone of obstructive BPH treatment consisted of mostly medical and to a lesser extent surgical therapies. However, while medical treatment has come to a standstill, over the last decade, new minimally invasive surgical therapies (MISTs) have emerged, conferring several possible advantages over conventional transurethral resection of the prostate (TURP). MISTs have also demonstrated the ability to better respect and preserve sexual function while providing safety and minimal morbidity. Their long-term efficacy and durability over drug therapy remain debatable, as is the need for secondary procedures. In the present paper, we aim to offer a narrative summary of the available literature, thus providing an indirect comparative assessment of drugs and MISTs for obstructive LUTS.