Retrospective Comparison of Transurethral ProstaticColumnar Water Balloon Dilation and Pharmacotherapyfor Moderate-to-Severe Benign Prostatic Hyperplasia:Efficacy, Safety and Compliance

Objective: This study aimed to compare the clinical efficacy, safety, and patient compliance of transurethral prostatic columnar water balloon dilation versus combination pharmacotherapy (α-blockers + 5α-reductase inhibitors) in patient with moderateto-severe benign prostatic hyperplasia (BPH). Methods: This retrospective analysis included 120 patient with moderate-to-severe BPH (International Prostate Symptom Score [IPSS] 8–35 points, January 2022–December 2025) After propensity score matching (1:1), patient were divided into a surgical group (n = 60, transurethral prostatic columnar water balloon dilation) and a medication group (n = 60, combined pharmacotherapy). Key outcomes assessed at baseline and 1, 3, and 6 months post-treatment included IPSS, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), prostate volume (PV), quality of life (QoL), adverse events (AEs), compliance, and satisfaction. Results: At all follow-up points, both groups showed significant improvements in IPSS, QoL, PVR, and voiding time (p < 0.05). At 6 months, outcomes were significant better in the surgical group than in the medication group: total IPSS (8.32 ± 2.34 vs. 14.22 ± 2.57), Qmax (20.59 ± 3.51 vs. 14.54 ± 3.51 mL/s), and PVR (29.58 ± 9.67 vs. 45.92 ± 12.51 mL) (all p < 0.05). PV decreased significantly in the medication group (52.13 ± 8.56 vs. 67.60 ± 10.12 mL, p < 0.05) but did not change significantly in the surgical group (p > 0.05). The surgical group had a lower unadjusted AE rate (6.7% vs. 20.0%, p = 0.032), but a higher standardized short-term procedural event rate. Complete compliance (95.0% vs. 68.3%, p < 0.001), and satisfaction (89.42 ± 6.83 vs. 73.62 ± 8.59, p < 0.001) were also higher in the surgical group. Conclusions: For moderate-to-severe BPH, transurethral prostatic columnar water balloon dilation provides superior short-tomedium-term efficacy, safety, and compliance compared with pharmacotherapy, making it particularly suitable for high-risk or medication-intolerant patients.