Impact of Prostatic Urethral Lift and Water Vapor Energy Therapy on Bladder Outlet Obstruction in Elderly or Comorbid Patients With Benign Prostatic Hyperplasia in Real‐World Clinical Practice

Objective To evaluate the effects of prostatic urethral lift (PUL) and water vapor energy therapy (WAVE) on bladder outlet obstruction (BOO) using pressure flow studies (PFS) in real‐world clinical practice among patients with benign prostatic hyperplasia (BPH), particularly those who are elderly or in poor general health. Methods This retrospective study included 128 men who underwent PUL ( n = 43), WAVE ( n = 38), or photoselective vaporization (PVP, n = 47) for BPH. Surgical procedure selection was based on a department‐specific proprietary algorithm. In elderly patients or those with systemic comorbidities, either PUL or WAVE was selected, and the choice between the two procedures was made based on prostate morphology. The primary endpoint was the change in bladder outlet obstruction index (BOOI) from baseline to 6 months after each surgical procedure. Results The BOOI (mean ± SD) significantly decreased from 59.5 ± 26.2 to 14.8 ± 16.7 after PVP, 39.7 ± 21.8 to 25.8 ± 17.7 after PUL, and 52.5 ± 23.9 to 21.9 ± 19.2 after WAVE (all p < 0.01). The International Prostate Symptom Score (IPSS) improved from 17.0 ± 8.8 to 7.0 ± 6.2 (PVP), 16.7 ± 9.0 to 11.5 ± 7.9 (PUL), and 14.7 ± 8.0 to 8.2 ± 6.3 (WAVE) (all p < 0.01). Maximum flow rate (Qmax) increased from 8.6 ± 5.0 to 17.3 ± 7.5 mL/s (PVP), 9.3 ± 5.9 to 12.5 ± 5.8 mL/s (PUL), and 9.2 ± 3.7 to 12.4 ± 6.0 mL/s (WAVE) (all p < 0.01). Despite improvements, residual BOO (Schafer grade ≥ III) remained in 6.4% of PVP, 16.3% of PUL, and 15.8% of WAVE patients. Conclusion In elderly patients or those with poor general health, both PUL and WAVE significantly improved the BOOI at 6 months postoperatively. However, in PUL and WAVE, persistent BOO exceeded 15%, suggesting that more appropriate patient selection will be necessary in the future.