Office-based procedures for benign prostatic hyperplasia, compared with transurethral resection
| Treatment | Transurethral resection of the prostate | Prostatic urethral lift procedure | Water vapor thermal therapy | Temporarily inserted nitinol device |
|---|---|---|---|---|
| Surgery type | Cystoscopic electric excision | Cystoscopic placement of sutures to open the urethra | Cystoscopic application of steam to ablate the prostate | Cystoscopic placement of a temporary urethral stent |
| Operative setting | Operating room | Office | Office | Office |
| Anesthesia | General or spinal | Local, sometimes with sedation | Local, sometimes with sedation | Local, 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 |
| Contraindications | Anticoagulation 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 |
| Advantages | Historical gold standard Widely accessible | Preserves sexual function | Preserves sexual function | Preserves sexual function |
| Postoperative catheter time | 1–3 days | None (some cases) | 3–7 days | None |
| Durability | Good | Poor | Good | Unknown |
| Erectile dysfunction | Uncommon | None | None | None |
| Unique complications | Electrolyte abnormalities (transurethral resection syndrome) | Expected retreatment Bladder stones | Transient retention from prostate edema | Dislodgement or migration |