Minimally Invasive Treatments for Prostatic Enlargement
UroLift and Rezūm offer a middle ground between long-term medication and definitive surgery for BPH. Mr. Jesuraj provides honest, balanced guidance on whether these procedures are appropriate for your situation — and where more definitive treatment is the better choice.
Ⓘ AN HONEST STARTING POINT
Mr. Jesuraj does not perform UroLift or Rezūm himself. He will give you an objective, evidence-based assessment of all your options — and refer you to an appropriate specialist if you decide to proceed with one of them after full discussion of the evidence.
His personal recommendation for patients suitable for surgical treatment is Aquablation — a procedure with stronger long-term evidence and more durable outcomes. But the decision is always yours, made on the basis of complete information.
UNDERSTANDING THE OPTIONS
Where Minimally Invasive Procedures Fit
Benign prostatic hyperplasia (BPH) causes a spectrum of lower urinary tract symptoms from mild to severely disabling. Treatment options span from lifestyle modification and medication through to definitive surgical procedures.
Minimally invasive procedures like UroLift and Rezūm sit in a specific gap — between long-term medication that has failed or is not tolerated, and more definitive surgical treatment where symptoms are not yet severe enough to warrant it. They offer the appeal of a short, low-risk procedure — but this comes with important trade-offs in terms of durability of benefit, patient selection limitations, and the possibility of needing further treatment.
Understanding where these procedures fit — and where they do not — is essential before making a decision. Mr. Jesuraj believes in giving patients the full picture.
Lifestyle & Watchful Waiting
Fluid management, caffeine reduction, bladder retraining. For mild symptoms with no complications.
Minimally Invasive — UroLift & Rezūm
For men who cannot tolerate medication or in whom it has failed, but where symptoms are not yet severe enough for definitive surgery — or where ejaculatory preservation is an absolute priority.
Medical Therapy
Alpha-blockers (tamsulosin), 5-alpha reductase inhibitors (finasteride), combination therapy. For moderate symptoms.
Definitive Surgical Treatment
Aquablation, TURP, HoLEP — for significant symptoms, large prostates, or when durable long-term relief is the priority.
UroLift — Prostatic Urethral Lift
Mechanical retraction of obstructing prostatic lobes using small permanent implants
COMPARISON
UroLift vs Rezūm vs Aquablation
An honest comparison across the procedures — including the one Mr. Jesuraj recommends and performs.
| Factor | UroLift | Rezūm | Aquablation |
|---|---|---|---|
| Mechanism | Mechanical retraction — no tissue removal | Steam thermal ablation — tissue destroyed | Robotic waterjet — precise tissue excision, no heat |
| Median lobe | ✘ Not suitable | ✓ Yes | ✓ Yes — any anatomy |
| Prostate size | 30–80ml only | 30–150ml | All sizes including very large |
| Anaesthetic | Local or GA | Local or GA | Spinal or general anaesthetic |
| Post-op catheter | Usually none | 1–2 weeks required | 1–2 days |
| Time to benefit | 2–4 weeks | 4–12 weeks | Weeks |
| Ejaculation preserved | Most patients | Most patients | Significantly lower risk than TURP |
| Key trial evidence | L.I.F.T. RCT (vs sham) | Rezūm RCT — McVary et al. (vs sham) | WATER trial vs TURP · WATER II large prostates |
| Long-term evidence | 5 years — limited beyond this | 5 years — industry-sponsored | Robust — independent RCT vs TURP |
| 5-year re-treatment | ~13% (L.I.F.T.) | Reported low — longer-term data awaited | Very low — strong durability data |
| NICE approved | Yes | Yes (2018) | Yes — 2023 |
| Available at Tees Urology | Via referral to specialist | Via referral to specialist | ✓ Mr. Jesuraj performs |
Honest Guidance — Not a Procedure Recommendation
Mr. Jesuraj does not perform UroLift or Rezūm. This is a deliberate clinical decision — not a commercial one. He believes that for the majority of men suitable for surgical treatment of BPH, more definitive procedures offer significantly more durable outcomes.
However, minimally invasive procedures have a genuine and important role for men in the specific gap between medical therapy and definitive surgery. This includes men who:
“My job is to ensure every patient fully understands their options, the evidence supporting each, and the honest limitations — including that the WATER and WATER II trial data, which is the most robust independent RCT evidence for any of these procedures, relates to Aquablation versus TURP. In some patients, especially those presenting with retention of urine or high risk of bleeding, I would strongly recommend them to go for TURP or Holmium Laser Enucleation. The choice of treatment should be married up with the needs and wants of the individual patient. If after full discussion a patient chooses UroLift or Rezūm, I will arrange referral to an appropriate specialist. What I will not do is recommend a procedure I believe is less likely to give a durable result without being transparent about that.”
– Mr. Manohar Jesuraj, Consultant Urological Surgeon
Interested?
Book a consultation with Mr. Jesuraj to find out if you are a suitable candidate. Appointments available within days.