If you are experiencing complete urinary retention (inability to empty the bladder), fever/chills, heavy bleeding, or severe pain, contact emergency or urgent care immediately.

Key facts

  • Prostatic urethral lift and water vapor thermal therapy are minimally invasive surgical therapies that result in less morbidity than transurethral resection. Prostate artery embolization is a minimally invasive treatment1.
  • Some procedures are limited to certain sizes, for example 30–80 g. Prostatic urethral lift should be considered when prostate volume is 30–80 g and an obstructive middle lobe is absent3. Water vapor thermal therapy should be considered when prostate volume is 30–80 g2.
  • The FDA doesn't approve medical procedures, but it does review the devices doctors use. In 2017, the FDA granted De Novo authorization (DEN160040) to Embosphere Microspheres for prostate artery embolization to treat BPH10. UroLift received a De Novo classification (DEN130023, 2013)6. Rezum received a 510(k) clearance (K150786, 2015)7.
  • Catheter use, anesthesia level, and retreatment rates should be framed as questions to ask, not rankings.
  • Five-year outcomes have been reported for Rezum4 and for UroLift in the L.I.F.T. study5.
  • Talk with your doctor before you decide. This information does not replace personal medical advice.

What the three share

A multisociety position statement calls prostatic urethral lift and water vapor thermal therapy minimally invasive surgical therapies, and it says those therapies result in less morbidity than transurethral resection. It calls prostate artery embolization a minimally invasive treatment1. The useful comparison is about your own prostate, symptoms, and priorities, not a single winner. For the wider list, see BPH treatment options and the BPH treatment options comparison.

Why this matters: A procedure can be a reasonable topic for one man and a poor fit for another with the same symptoms. Ask each specialist to explain the fit in your case before you compare anything else.

Questions to ask

  • Which of these three, if any, fits my prostate and my symptom pattern?
  • What would make you rule one of them out for me?
  • Should classic resection surgery also stay on my list, as on the PAE vs TURP page?

Prostate size and the middle lobe

Some procedures are limited to certain sizes, for example 30–80 g, as the questions before PAE page also notes2. Prostatic urethral lift should be considered when prostate volume is 30–80 g and an obstructive middle lobe is absent3. Water vapor thermal therapy should be considered when prostate volume is 30–80 g2. That guideline does not set the 30–80 g range for prostate artery embolization. The multisociety statement says prostate artery embolization is effective in large prostates, with no maximum prostate size1. Bring your own size and anatomy results, and use the prostate size and anatomy terms guide to read them.

Questions to ask

  • What is my prostate volume, and do I have a middle lobe?
  • How do my size and middle lobe change which of these three apply to me?
  • Which imaging or test results do you want before you answer?

What FDA status means here

The FDA doesn't approve medical procedures, but it does review the devices doctors use. In 2017, the FDA granted De Novo authorization (DEN160040) to Embosphere Microspheres for prostate artery embolization to treat BPH10. UroLift received a De Novo classification (DEN130023, 2013)6. Rezum received a 510(k) clearance (K150786, 2015)7. A device classification or clearance is not, by itself, an answer about which procedure fits you.

Questions to ask

  • When you describe an option, are you talking about a classified or cleared device, the procedure itself, or both?
  • For PAE, which embolic agent would you use, and what is its clearance status?
  • What evidence, besides classification or clearance, do you rely on for men like me?

Recovery, catheter, and anesthesia: questions, not rankings

Catheter use, anesthesia level, and retreatment rates should be framed as questions to ask, not rankings. Recovery after PAE alone is covered in the PAE recovery guide.

Questions to ask

  • Would I have a catheter with this option, and for how long?
  • What level of anesthesia would I need?
  • How often do men need retreatment after this option, and what would retreatment look like?
  • Which BPH procedure has the shortest recovery for someone in my situation, and what does that claim rest on?

How long results last

Five-year outcomes have been reported for Rezum4 and for UroLift in the L.I.F.T. study5. For PAE, a randomized trial compared PAE with a sham procedure8, a multisociety position statement covers PAE1, and a UK guidance page covers PAE9. Ask how long each study followed its patients before you compare the results.

Questions to ask

  • How many years of follow-up sit behind the results you are quoting for each option?
  • Were the men in that study similar to me in size and symptoms?
  • What happens if my symptoms come back years later?

Questions to ask before you decide

Prostate size and an obstructive middle lobe change which options the surgical guideline supports3. Talk with your doctor before you decide. If PAE is on your list, bring questions to ask before PAE. Other enlarged-prostate topics are in the BPH article library.

Questions to ask a urologist

  • How do Rezum and UroLift compare for my size, middle lobe, and symptoms?
  • What would each cost me, and what does my coverage say?
  • If I had UroLift or Rezum first, which later options would stay open?

Questions to ask an interventional radiologist

  • How does PAE compare with Rezum and UroLift for my size, middle lobe, and symptoms?
  • Can PAE follow an earlier UroLift or Rezum treatment in my case?
  • What would PAE cost me, and what does my coverage say?

Common questions

PAE vs Rezum: which is better?

A multisociety statement calls prostatic urethral lift and water vapor thermal therapy minimally invasive surgical therapies, which result in less morbidity than transurethral resection, and it calls prostate artery embolization a minimally invasive treatment1. Some procedures are limited to certain sizes, for example 30–80 g2. Which one fits you depends on your prostate and your symptoms. Talk with your doctor before you decide.

PAE vs UroLift for a large prostate?

Some procedures are limited to certain sizes, for example 30–80 g2. Prostatic urethral lift should be considered when prostate volume is 30–80 g and an obstructive middle lobe is absent3. Water vapor thermal therapy should be considered when prostate volume is 30–80 g2. The same guideline does not set that 30–80 g range for prostate artery embolization2. The multisociety statement says prostate artery embolization is effective in large prostates, with no maximum prostate size1. Ask how your size and middle lobe change which options apply to you. Talk with your doctor before you decide.

How does the FDA review devices used in prostate artery embolization (PAE)?

The FDA doesn't approve medical procedures, but it does review the devices doctors use. In 2017, the FDA granted De Novo authorization (DEN160040) to Embosphere Microspheres for prostate artery embolization to treat BPH10. UroLift received a De Novo classification (DEN130023, 2013)6. Rezum received a 510(k) clearance (K150786, 2015)7. Talk with your doctor before you decide.

Which BPH procedure has the shortest recovery?

Catheter use, anesthesia level, and retreatment rates should be framed as questions to ask, not rankings. Ask each specialist what recovery, catheter use, and anesthesia would look like for you. Talk with your doctor before you decide.

Can you have PAE after UroLift?

Whether PAE can follow UroLift or another earlier treatment is not answered in one rule for everyone. Ask a urologist and an interventional radiologist how an earlier procedure changes the options they can offer you. Talk with your doctor before you decide.

Ready to build your BPH checklist?

Select the topics that apply to your upcoming non-urgent visit and get a personalized question checklist to bring to your clinician.

Build my bph checklist

Talk with your doctor before you decide. This information does not replace personal medical advice. Read the medical disclaimer.

Sources

  1. Multisociety position statement on PAE (PMID 30926185) ↩︎
  2. American Urological Association, BPH guideline amendment 2023 (PMID 37706750) ↩︎
  3. American Urological Association, BPH guideline Part II (PMID 34384236) ↩︎
  4. Rezum five-year outcomes (PMID 33872051) ↩︎
  5. UroLift L.I.F.T. five-year results (PMID 28646935) ↩︎
  6. UroLift De Novo classification (DEN130023) ↩︎
  7. Rezum 510(k) clearance (K150786) ↩︎
  8. Pisco 2020, PAE compared with a sham procedure (PMID 31831295) ↩︎
  9. NICE guidance on PAE, IPG611 ↩︎
  10. FDA De Novo DEN160040 (granted 2017-06-21, Embosphere Microspheres) ↩︎