Prostatic Urethral Lift May Provide More Durable Symptom Relief than Water Vapor Thermal Therapy

Men who underwent prostatic urethral lift (PUL) procedures were more likely to discontinue medical therapy for benign prostatic hyperplasia (BPH) 6 months after the intervention compared with those treated with water vapor thermal therapy (WVTT), according to a retrospective analysis presented at the 2026 Annual Meeting of the American Urological Association (AUA 2026) in Washington, D.C.

Minimally invasive surgical therapies, including PUL and WVTT, have gained popularity in recent years due to their favorable safety profiles and their ability to preserve sexual function. Nevertheless, clinical trials and real-world data have reflected a mixed picture of the postoperative experience among patients with BPH, with durability of symptom relief varying across different procedures. While post-surgery medication use is an important consideration in the management of patients with BPH, this discussion rarely takes priority in the real-world clinical setting. 

In a retrospective analysis of more than 400 patients with BPH, researchers at The Chinese University of Hong Kong used propensity score matching to compare the drug-free status and the rates of unplanned readmissions for patients who underwent either PUL or WVTT procedures between January 2021 and December 2024 at the S.H. Ho Urology Centre. After propensity score matching, the study included 174 men who underwent WVTT procedures and 58 men treated with PUL. Participants were aged over 50 years (with a mean age of 72 years) and had prostate volumes ranging from 30 to 80 cc.
  
Both minimally invasive surgical options demonstrated a favorable safety profile, with no reinterventions recorded within the first year. However, the PUL procedure was associated with a significantly greater likelihood of achieving drug-free status at 6 months compared to WVTT. Subgroup analyses also showed that PUL achieved higher rates of medication discontinuation in patients with larger prostate sizes (>50 cc) and in catheter-dependent patients. No statistically significant difference was observed between the two groups in terms of unplanned readmissions within 30 days after the procedures. The authors noted that this finding could be attributed to the low number of readmission events across the cohort. 

“This study demonstrates a statistically significant advantage for PUL over WVTT in enabling patients to discontinue BPH medications at 6 months, positioning PUL as a compelling minimally invasive surgical option with a comparable safety profile for patients prioritizing cessation of medication,” the authors concluded. In the absence of uniform guidelines for resuming BPH medications after minimally invasive surgery, patients could benefit from closer surveillance after undergoing procedures such as PUL and WVTT. 
A separate retrospective analysis featured at AUA 2026 showed that PUL was more likely to reduce the risk of ejaculatory dysfunction than WVTT. The propensity score-matched real-world cohort included a total of 8,102 patients who underwent either PUL or WVTT (4,051 per group), who were followed up for a median period of 33.7 months (PUL) and 25.1 months (WVTT). 

While no significant difference was observed in the risk of erectile dysfunction between the two groups, PUL was associated with a significantly lower risk of ejaculatory dysfunction. Men who underwent PUL procedures had significantly improved ejaculatory dysfunction-free survival compared to those treated with WVTT (98.8% vs. 97.5% at 5 years, with a hazard ratio of 0.50). “Although the absolute difference was modest, the relative reduction may be clinically meaningful for patients prioritizing preservation of ejaculatory function,” the authors noted. “These findings support a more individualized, patient-centered approach to treatment selection.”