There are several types of procedure currently available for treatment of benign prostate enlargement causing bothersome urinary symptoms. PREMISE will compare 4 different procedures currently available within the NHS to see how effective they are.

Transurethral resection of the prostate (TURP) is a surgical procedure that involves cutting away a section of the prostate. This has been the main procedure performed for treatment of symptoms due to benign prostate enlargement for a number of years; it is known to be effective and is a widespread and standardised procedure. This procedure requires a spinal or general anaesthetic and usually a 1-to-3-day hospital stay. More recently, a number of alternative minimally invasive procedures have become available. These usually require a shorter time in hospital and potentially a lower risk of complications and long-term side effects. This study hopes to confirm whether they are as effective at treating symptoms caused by benign prostate enlargement as the main procedure, TURP.

PREMISE will compare the effectiveness of TURP with three other minimally invasive procedures currently available in NHS practice (Rezum Water Vapour Therapy, Prostatic urethral lift and iTIND).  PREMISE will also compare the cost-effectiveness of the procedures, looking at costs from an NHS and patient perspective and outcomes in terms of impact on quality of life.  The PREMISE trial will also compare how acceptable participants find each procedure and their side effects. We hope the results will inform future care within the NHS. See pages 2-3 for more information on each of these surgeries.