Key facts

  • Federal health information groups transurethral water vapor therapy and the prostatic urethral lift under "minimally invasive surgical therapies," separate from watchful waiting, medicines, and operations such as TURP1.
  • Watchful waiting and medicines don't need a procedure, but neither is a one-time fix2.
  • Anesthesia, catheter needs, same-day discharge, and recovery time vary by specific option and by person, not by category alone.
  • In a sham-controlled trial, a temporarily placed device improved symptom scores at 12 months, and the study authors described their results as preserving sexual function6.
  • PAE has been tested against a sham procedure; at 5 years in one trial, its improvement was smaller than TURP's9,10.
  • Some device options were studied in prostates under a certain size, so size and shape decide what can be discussed11.
  • Talk with your doctor before you decide. This information does not replace personal medical advice.

Define what you are hoping to avoid

"Without surgery" means different things to different people. Federal health information groups transurethral water vapor therapy and the prostatic urethral lift under "minimally invasive surgical therapies," as a category separate from watchful waiting, medicines, and operations such as TURP, laser surgery, and robotic surgery1. Before comparing options, it helps to name what you actually want to avoid: general anesthesia, a cut, an overnight stay, a catheter afterward, or a change in ejaculation.

Questions to ask

  • When I say "without surgery," what exactly am I hoping to avoid?
  • Which category does a specific option fall into: watchful waiting, medicine, a minimally invasive device, or surgery?
  • Does that category change how the option is billed or covered?

Watchful waiting and medicines

Watchful waiting means regular checkups instead of starting medicine or a procedure right away1. Medicines either relax the muscles around the bladder neck and prostate (alpha-blockers) or lower prostate hormones to shrink the prostate somewhat, such as finasteride and dutasteride2. Neither needs a procedure, but neither is a one-time fix. Read medication for BPH for more.

Questions to ask

  • Am I a reasonable candidate for watchful waiting, or do my symptoms already suggest a procedure?
  • Which medicine fits my situation, and what does it mean to "try" it?
  • What happens if I stop a medicine later?

If you want to avoid general anesthesia

Anesthesia for a given option can range from local numbing medicine to sedation to general anesthesia, and that depends on the specific technique and the person, not just the name of the category it falls into. This is not settled by knowing an option's name alone.

Questions to ask

  • What anesthesia or sedation does this specific option use, in your practice?
  • Who decides that, and can it be changed?
  • What would change about my options if I cannot tolerate general anesthesia?

If you want to avoid a cut

UroLift's FDA record describes it as an "implantable transprostatic tissue retractor system"3. Rezum delivers water vapor into prostate tissue, one of the two devices federal sources group under "minimally invasive surgical therapies"1, and it reached the market through a separate FDA pathway in 20154. iTind's FDA record describes it as a "temporarily-placed urethral opening system"5. Ask your own doctor exactly how a specific option reaches the prostate, and whether that counts as a cut in your case.

Questions to ask

  • Does this option involve any cut, and where?
  • If it is placed through the urethra, does that change recovery or risk?
  • Would a different option change the answer?

If you want to avoid an overnight stay

Whether you go home the same day or stay overnight depends on the specific option, the clinician, and sometimes on you. It is not something to assume from a device's category.

Questions to ask

  • Is this option usually done the same day, in your practice?
  • What would turn a same-day plan into an overnight stay?
  • Who should be told if I need to stay longer than planned?

If you want to avoid a catheter afterward

Whether a catheter is needed afterward, and for how long, varies by option and by person. Ask directly rather than assuming based on the category an option falls into.

Questions to ask

  • How likely am I to need a catheter after this option, and for how long, in your experience?
  • What would make that longer than expected?
  • Who do I call if a catheter is still in place when I expected it to be out?

If you want to avoid a change in ejaculation or sexual function

In a sham-controlled trial of a temporarily placed device (iTind), symptom scores improved at 12 months, and the study authors described their results as preserving sexual function6. A 2026 interventional radiology practice guidance for prostate artery embolization says PAE can be considered for men with moderate to severe urinary symptoms who want to preserve erectile or ejaculatory function or avoid urinary incontinence, and reports retrograde ejaculation after PAE in less than 2% of men7. That is not a guarantee: sexual side effects are still possible with PAE and with other options, so ask what is known for the specific option you are considering. See which BPH treatments have fewer sexual side effects.

Questions to ask

  • What is known about this specific option and ejaculation or erections?
  • Is that based on a trial, a smaller study, or general experience?
  • What would I ask about if this matters more to me than symptom relief?

Prostate artery embolization (PAE)

PAE is done by an interventional radiologist. A thin catheter delivers tiny particles into the arteries that feed the prostate. Those particles received a device classification described as "agents, embolic, for treatment of benign prostatic hyperplasia" in 20178, which classifies the particles, not the procedure as a whole. PAE has been tested against a sham (placebo) procedure in a randomized trial9. In a different randomized trial, the improvement after PAE at 5 years was smaller than after TURP, and the authors concluded PAE was inferior10.

A 2026 interventional radiology practice guidance describes PAE as an option for men who are not considered candidates for surgery because of older age, several other medical conditions, a bleeding disorder, or being unable to stop blood-thinning medicines7. The same guidance also covers men who refuse surgery or who prefer a procedure without prior medical therapy7. The guidance describes PAE as durable for most men but reports that about 20–25% need a second procedure by 5 years, rising over time; in one cohort of 1,072 men, reintervention was 21.1% at 5 years and 58.1% at 10 years7. Ask how this compares with the other options you are considering. Read what PAE is.

Questions to ask

  • Why would PAE be discussed for my situation specifically?
  • How does PAE compare with other options for the outcomes that matter most to me?
  • How will we know if I need another procedure later?
  • How often do men need another procedure after each option I'm considering?

Not surgery, but still a procedure

UroLift, Rezum, iTind, and PAE each reach the prostate differently, but each is still a procedure: each carries its own risks, needs its own anesthesia or sedation plan, and needs follow-up. None of them is guaranteed to avoid every side effect that comes with surgery. Surgery such as TURP or laser surgery is also an option to weigh. It is not only a fallback, and in one randomized trial TURP gave a larger symptom improvement than PAE at 5 years10.

Ask the same questions about each option: what is actually done, what anesthesia or sedation is used, how long recovery takes, and what happens if symptoms come back.

Questions to ask

  • What exactly is done during this option, step by step?
  • What would make this option a poor fit compared with surgery, in my case?
  • What follow-up is planned, and who do I contact between visits?

Size and shape may matter

Some device options were studied in prostates under a certain size, so size and shape decide what can be discussed11. Study limits are not a promise about your own prostate. See prostate size, anatomy terms, and report terms to ask about for the vocabulary, and compare all BPH treatment options side by side.

Questions to ask

  • What is my prostate size, and where did that number come from?
  • Does my size or shape rule any option in or out?
  • If size rules out one option, what does that leave?

Questions to ask before you decide

Name what you want to avoid, bring that list to your doctor, and ask how each option you are offered compares on that specific point. Compare the broader category map in BPH treatment options and all BPH treatment options side by side, and review medication for BPH if a medicine is on your list.

Questions to ask

  • Of the options you would offer me, which best avoids what matters most to me?
  • What would change your recommendation if my priorities were different?
  • What happens next if this option doesn't work for me?

Common questions

Is PAE surgery?

PAE isn't an operation on the prostate itself: particles are delivered through a catheter placed in an artery that feeds the prostate9. It is still a procedure, with its own risks, recovery, and follow-up.

Are UroLift and Rezum surgery?

Federal health information places the prostatic urethral lift and transurethral water vapor therapy in a category called "minimally invasive surgical therapies," separate from watchful waiting, medicines, and bigger operations1. They are procedures, just not the same as major surgery.

What medicines treat BPH without a procedure?

Alpha-blockers relax the muscles around the bladder neck and prostate, and medicines such as finasteride and dutasteride lower prostate hormones to shrink the prostate somewhat2. Neither is a one-time fix.

Does any option guarantee no change in ejaculation?

No. A sham-controlled trial of a temporarily placed device reported preserved sexual function in its results6, and a 2026 interventional radiology practice guidance for prostate artery embolization says PAE can be considered for men with moderate to severe urinary symptoms who want to preserve erectile or ejaculatory function or avoid urinary incontinence, and reports retrograde ejaculation after PAE in less than 2% of men7. Sexual side effects are still possible with any of these options, so ask what is known for the specific option you are considering.

Does the FDA review PAE?

The particles used in PAE received a device classification for treating BPH in 20178. That is a classification of the particles, not an approval of the procedure as a whole.

Does prostate size limit which option I can have?

It can. Some device options were studied in prostates under a certain size, so size and shape decide what can be discussed11, but study limits are not a promise about your own prostate. Ask your own doctor.

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

Sources

  1. NIDDK, Prostate Enlargement (Benign Prostatic Hyperplasia) ↩︎
  2. MedlinePlus, enlarged prostate ↩︎
  3. UroLift System, FDA De Novo classification (DEN130023) ↩︎
  4. Rezum System, FDA 510(k) clearance (K150786) ↩︎
  5. iTind System, FDA De Novo classification (DEN190020) ↩︎
  6. Chughtai et al., iTind sham-controlled trial, Urology 2021 (PMID 33373708) ↩︎
  7. Society of Interventional Radiology (SIR), 2026 practice guidance for prostate artery embolization (PMID 42223385) ↩︎
  8. Embosphere Microspheres, FDA De Novo classification (DEN160040) ↩︎
  9. Pisco et al., PAE vs sham randomized trial (PMID 31831295) ↩︎
  10. Müllhaupt et al., PAE vs TURP 5-year results (PMID 38531756) ↩︎
  11. Canadian Urological Association BPH guideline, 2022 (PMID 35905485) ↩︎