Surgery remains the cornerstone treatment of bothersome lower urinary tract symptoms (LUTS) secondary to benign prostatic obstruction (BPO) refractory to conservative/medical treatment. The principle is to relieve the obstruction generated by the hyperplastic tissue of the transitional zone, thus widening the prostatic urethra and improving voiding pressures. According to the Non-neurogenic Male LUTS guidelines panel of the European Association of Urology (EAU), surgical treatment is recommended for men with moderate-to-severe LUTS who either don’t respond to conservative therapy or to those who refuse or are not suitable for medical therapy and request active treatment. The surgical treatment options are conventionally classified into established techniques and techniques under investigation. Established techniques include transurethral incision of the prostate (TUIP), monopolar transurethral resection of the prostate (M-TURP), bipolar transurethral resection of the prostate (B-TURP), bipolar transurethral vaporization of the prostate (B-TUVP), open prostatectomy, laser treatments of the prostate, prostatic urethral lift, image-guided robotic waterjet ablation (Aquablation) and Prostatic artery embolization. Techniques under investigation include: Minimal invasive simple prostatectomy, temporary stenting (iTIND), and water vapor therapy (Rezum system).