Thorough evaluation of microwave technology has led to the clinical application of several principles of microwave radiation for the thermotherapy of the prostate. First, the efficacy and safety of the method was demonstrated in animal and human experimental models with the generation of high intraprostatic temperatures and subsequent thermal ablation of the prostate tissue without the risk of injury to adjacent organs. Experimental studies also focused on the investigation of potential mechanisms of heat action and on the identification of those parameters that may affect the response to thermal therapy and optimize clinical outcomes. Several studies on the role of transurethral microwave therapy (TUMT) for the management of patients with lower urinary tract symptoms due to benign prostatic hyperplasia have been published. Based on the best current available evidence, clinical outcomes, durability, morbidity, outcome predictors, and costs are analyzed. In addition, the acceptance and current position of TUMT are highlighted. © 2012 Blackwell Publishing Ltd.