To investigate the safety and therapeutic efficacy of transurethral water vapor thermal therapy under local anesthesia in patients with different degrees of benign prostatic hyperplasia (BPH).

A retrospective analysis was conducted on 96 patients who underwent transurethral water vapor thermal therapy from June 2023 to June 2024. Patients were divided into two groups based on preoperative prostate volume: <80 mL group and ≥80 mL group. Data of perioperative clinical characteristics were collected, and postoperative efficacy, adverse events, and complications were evaluated.

All patients successfully underwent the procedure under local infiltration anesthesia, with an average of (7.03±2.88) needle insertions performed. Postoperative international prostate symptom score (IPSS), maximum urinary flow rate (Q_max), quality of life (QOL), and post-void residual (PVR) in both groups showed a continuous improvement trend (all P<0.001). Moreover, in patients who maintained sexual activity preoperatively, the International Index of Erectile Function-5 (IIEF-5) scores showed no significant differences in both groups (P>0.05), with only the ≥80 mL group demonstrating a transient decline at 1 month postoperatively (P=0.042). The main postoperative complications included urinary tract infection (19.8%), urinary retention (17.7%), urinary frequency and urgency (15.6%), most of which were classified as Clavien-Dindo grade I/II, and there were no significant differences in postoperative complication rates between the two groups (all P>0.05).

Transurethral water vapor thermal therapy which serves as an ultra-minimally invasive treatment for BPH, can significantly improve urinary function and preserve sexual function. It is equally safe and effective for patients with large prostate volumes.