Transurethral Thermodilatation vs. Prostatic Urethral Lift for Moderate-to-Severe BPH

This clinical trial aims to determine whether Prolieve® (microwave with balloon dilation) is as effective as UroLift® (prostate implants) for treating moderate-to-severe lower urinary tract symptoms in men aged 50-80 with enlarged prostates (BPH) who have failed oral medications.

The main questions are:

1. Is Prolieve non-inferior to UroLift in improving IPSS symptom scores at 3 months?
2. Does Prolieve cause less pain and avoid the need for injected anaesthesia?

Researchers will compare Prolieve (LA urethral gel only, no injections) against UroLift (LA urethral gel with or without local anaesthetic injection) to see if Prolieve offers similar relief with better tolerability.

Participants will stop their BPH medications for 2-4 weeks, undergo one of the two same-day office procedures, and attend follow-ups at 1, 3, 6, and 12 months for symptom scores, flow tests, and bladder scans.