Surgical Treatment Options for Benign Prostatic Obstruction

Beyond Prostate Volume

Claudia Deyirmendjian; Dean Elterman; Bilal Chughtai; Kevin C. Zorn; Naeem Bhojani


Curr Opin Urol. 2022;32(1):102-108. 

In This Article

High Anesthesia-related Risks

General anesthesia may not be recommended for older patients with accrued comorbidities or an elevated ASA score. Urological procedures to treat BPO may be performed under general, spinal or local anesthesia, the latter imposing the lowest risk. Many novel minimally invasive techniques such as UroLift, Rezūm, PAE, and iTind may present safer options for patients vulnerable to anesthesia-related complications, as they can be performed under local anesthesia.

UroLift can be performed under local anesthesia, as confirmed by a prospective study (n = 51) by Shore et al. in which 98% of UroLift procedures were done using a topical anesthetic with oral sedation and/or analgesia. No patients required conversion to general anesthesia and adverse events (mild to moderate) resolved within one month.[47] Rezūm is also feasible under local anesthesia.[48] The meta-analysis by Tanneru et al. indicated that the majority of Rezūm patients underwent the procedure under local anesthesia with sedation.[49] PAE is similarly performed under local anesthesia with sedation and is not limited to patients with small prostates.[50,51] Finally, for iTind procedures, both insertion and removal techniques may be performed using local anesthesia.[52]