AIM: To investigate the clinical efficacy of transurethral columnar balloon dilation of prostate (TUCBDP) in the treatment of small-volume benign prostatic hyperplasia (BPH) and provide the optimal treatment for the surgical treatment of small volume benign prostatic hyperplasia. METHODS: This retrospective study analyzed 106 patients with small-volume BPH who underwent surgical treatment at the Department of Urology, Xiangya Changde Hospital from December 2023 to January 2024. The patients were divided into two groups based on the type of surgery received: TUCBDP group (n = 53) and transurethral resection of prostate (TURP) group (n = 53), which serves as the control group. We observed and measured the primary outcome indexes of the two groups, including international prostate symptom score (IPSS), maximum urinary flow rate (Qmax), postvoid residual (PVR), and quality of life (QoL) score, as well as the secondary outcome indicators, such as operation time, hospital stay, indwelling catheter time, the frequency of night urination and daytime urination, and the total incidence of long-term and short-term complications. RESULTS: Preoperative IPSS, Qmax, PVR, and QoL scores showed no significant differences between the TUCBDP and TURP groups (p > 0.05). Postoperatively, the TUCBDP group showed superior results in terms of shortened operation time (–15.96 minutes, 95% confidence interval (CI) [–20.06, –11.86], p < 0.001), hospitalization time (–1.73 days, 95% confidence interval (CI) [–2.26, –1.20], p < 0.001), and indwelling catheter time (–1.17 days, 95% CI [–1.55, –0.79], p < 0.001), reduced night urination frequency (–0.71 times, 95% CI [–0.89, –0.53], p < 0.001) and daytime urination frequency (–1.80 times, 95% CI [–2.25, –1.35], p < 0.001). For patients receiving TUCBDP, improvements were also noted in IPSS (–2.27, 95% CI [–3.58, –0.96], p < 0.001), Qmax (4.50 mL/s, 95% CI [3.30, 5.70], p < 0.001), PVR (–6.89 mL, 95% CI [–9.48, –4.30], p < 0.001), and QoL (–0.87, 95% CI [–1.57, –0.17], p = 0.026). The TUCBDP group also had lower rates of near-term (15.09% vs. 35.85%, χ2 = 6.013, p = 0.014) and long-term complications (11.32% vs. 37.74%, χ2 = 9.988, p = 0.002). CONCLUSIONS: TUCBDP demonstrates significant clinical efficacy in the treatment of small-volume BPH, causing a low incidence of postoperative complications.