Office-based procedures for benign prostatic hyperplasia, compared with transurethral resection

TreatmentTransurethral resection of the prostateProstatic urethral lift procedureWater vapor thermal therapyTemporarily inserted nitinol device
Surgery typeCystoscopic electric excisionCystoscopic placement of sutures to open the urethraCystoscopic application of steam to ablate the prostateCystoscopic placement of a temporary urethral stent
Operative settingOperating roomOfficeOfficeOffice
AnesthesiaGeneral or spinalLocal, sometimes with sedationLocal, sometimes with sedationLocal, sometimes with sedation
Ideal prostate size≤ 80 cc (sometimes a bit larger)≤ 80 cc with no median lobe enlargement≤ 80 cc (sometimes a bit larger)< 75 cc, with no median lobe enlargement
Elevated bleeding risk
Narrow urethra
Large median lobe
High bladder neck
Allergy to implant
Fibrotic gland (due to prior procedure for prostatic hyperplasia or radiation)Large median lobe
Larger gland
Fibrotic gland
AdvantagesHistorical gold standard
Widely accessible
Preserves sexual functionPreserves sexual functionPreserves sexual function
Postoperative catheter time1–3 daysNone (some cases)3–7 daysNone
Erectile dysfunctionUncommonNoneNoneNone
Unique complicationsElectrolyte abnormalities (transurethral resection syndrome)Expected retreatment
Bladder stones
Transient retention from prostate edemaDislodgement or migration