Objective To investigate the degree and short-term outcome of perihematomal edema (PHE) after intracerebral hemorrhage following stereotactic therapy combined with urokinase versus medication alone.Methods A retrospective analysis was performed for the clinical data of 96 patients who received stereotactic therapy combined with urokinase or medication alone in Zhangjiajie Hospital of Hunan Normal University from January 2015 to June 2019. The patients were matched at a ratio of 1:1 using the propensity score matching method, and the matching variables included age, sex, whether it broke into the ventricle, ICH score, GCS score, baseline hematoma volume, baseline blood glucose, baseline systolic pressure, and baseline diastolic pressure. Finally, 28 patients who completed minimally invasive stereotactic drainage combined with urokinase were enrolled as stereotactic group and 28 patients who received medication alone were enrolled as medication group.Results There were no deaths during treatment in the two groups. Edema extension distance (EED), hematoma volume, and total volume of hematoma and edema changed significantly with time (P<0.05), and there was a significant interaction between group and time of measurement for hematoma volume and total volume (P<0.05). The two groups had a similar EED on admission and on days 1 and 3 after treatment (P>0.05), and the stereotactic group had a non-significantly larger EED than the medication group on day 3 after treatment. The stereotactic group had a significantly lower volume of hematoma than the medication group on days 1, 3, and 7 after treatment (P<0.01), and the stereotactic group had a significantly lower total volume than the medication group on days 1 and 3 after treatment (P<0.01). The two groups had similar ADL and mRS scores at 1 month after treatment (P>0.05).Conclusions Compared with medication alone, although minimally invasive stereotactic drainage combined with urokinase can significantly reduce the mass effect, it may not improve PHE and short-term functional prognosis.