Purpose <p>To investigate the use of local anesthesia in the UroLift^® procedure for the treatment of benign prostatic hyperplasia (BPH), focusing on anesthetic modality, pain management, patient comfort, and the feasibility of performing the procedure in outpatient or office-based settings without general or spinal anesthesia.</p> Materials and methods <p>A systematic review was conducted across PubMed/Medline, Embase, Scopus, and Web of Science databases up to November 2024. Studies were included if they involved BPH patients undergoing UroLift^® with local anesthesia, including techniques such as prostatic nerve blocks, transurethral intraprostatic anesthesia, and anesthetic gel. The review followed PRISMA guidelines.</p> Results <p>Ten studies met the inclusion criteria, evaluating techniques like topical lidocaine instillation, with consistent or patient-requested sedation, and prostatic nerve blocks. Most studies reported satisfactory pain control and high patient tolerability, with Visual Analog Scale pain scores ranging from 0.75 to 5.0. However, variability in anesthesia protocols and inconsistent pain assessment methods were noted. Local anesthesia was found feasible for outpatient procedures, reducing the need for general anesthesia and its associated risks.</p> Conclusions <p>Local anesthesia for UroLift^® is effective, well-tolerated, and a viable option for outpatient BPH treatment. However, the lack of standardized protocols and inconsistent outcome measures limits the ability to compare results across studies. Future research should focus on standardizing anesthesia techniques and conducting large-scale trials to improve procedural consistency and patient care.</p>