After transurethral and transrectal microwave hyperthermia were found to be no more beneficial in the treatment of benign prostatic hyperplasia than a sham treatment, transurethral microwave thermotherapy has emerged as a viable minimally invasive treatment alternative in men with lower urinary tract symptoms secondary to benign prostatic hyperplasia. Several well conducted, randomized, controlled trials demonstrated superiority over sham treatment. Most recent efforts are directed at identifying pretreatment outcome predictors and the best candidates for this therapy.