An enlarged prostate is a common reason men see a urologist. The medical name is benign prostatic hyperplasia, or BPH. Benign means it is not cancer. As the prostate grows, it can squeeze the urethra, the tube that carries urine out of the body. That can cause a weak stream, trouble getting started, getting up at night to urinate, and a feeling that your bladder never fully empties.
Many men do well with lifestyle changes or medicine. When they do not, there are now many procedures to choose from. Here is how to think about them.
When does a procedure make sense?
A procedure is worth considering when:
- Your symptoms still bother you despite medicine, such as an alpha-blocker (which relaxes the muscles in the prostate and bladder) or a 5-alpha-reductase inhibitor (which shrinks the prostate over time)
- Medicine causes side effects you do not want, such as dizziness or sexual side effects, or you would rather not take a pill every day for years
- The prostate is causing problems, such as not being able to urinate (urinary retention), repeated urinary infections, bladder stones, repeated bleeding, or urine backing up toward the kidneys
Urinary symptoms can also come from other conditions, including an overactive bladder or prostate cancer. So the first step is making sure the prostate is really the cause.
What tests help decide which procedure?
The choice depends on details that only testing can show. Common tests include:
- A symptom questionnaire, such as the International Prostate Symptom Score (IPSS)
- A urine flow test, which measures the strength of your stream, and a bladder scan after you urinate to see how much urine is left behind
- A measurement of prostate size, usually by ultrasound, or from an MRI or CT if you already had one
- A cystoscopy, a look inside the urethra and prostate with a thin camera. It shows the shape of the gland, including whether you have a middle lobe (a part of the prostate that bulges up into the bladder)
- A PSA blood test when appropriate, to look for signs of prostate cancer
What are the trade-offs?
Each procedure balances a few things differently:
- Prostate size and shape. Some options are designed for small to medium prostates. Others work across a wider range, and very large prostates often do better with surgery that removes the inner part of the gland. A middle lobe can rule some options in or out.
- Anesthesia. Some procedures can be done with local numbing or light sedation. Others need general anesthesia, where you are fully asleep.
- Catheter time. Many procedures leave you with a catheter, a thin tube that drains urine from your bladder, while you heal. That can range from none at all to about a week.
- Recovery. Some procedures bring relief within days to weeks. Others take longer, as treated tissue heals and is absorbed by the body. Burning and urgency (a sudden, strong need to urinate) are common for a while after some treatments.
- Ejaculation. Procedures that remove tissue can cause retrograde ejaculation, where semen goes backward into the bladder instead of out. It is not harmful, and orgasm usually still happens, but little or no fluid comes out. This matters to many men, especially those who hope to father children. Some options carry less risk of it.
- Durability. Procedures that remove more tissue tend to give relief that lasts longer. Less invasive options may be more likely to need a second procedure in later years.
How do the options compare?
Dr. Su performs each of the procedures below. This table is a general guide. Details vary from man to man, and your own plan may differ.
| Procedure | How it works | Anesthesia and stay | Catheter and recovery | Ejaculation |
|---|---|---|---|---|
| UroLift | Small implants lift and hold the enlarged tissue away from the urethra. No tissue is removed. | Minimally invasive and outpatient | Often no catheter, or only briefly. Relief often within a few weeks. | Less risk of ejaculatory problems |
| Rezūm | Steam (water vapor) destroys prostate tissue, which the body absorbs over time. | Minimally invasive and outpatient | Often a catheter for a few days. Can be more irritative after the procedure. Relief builds over weeks to a few months. | Less risk of ejaculatory problems |
| GreenLight laser | A laser destroys (vaporizes) excess prostate tissue. | General anesthesia; can be outpatient | Less bleeding. Often a short catheter time. Can be more irritative afterward. | Retrograde ejaculation is possible |
| Aquablation | A robot-guided, heat-free water jet removes excess tissue, following a map planned on ultrasound. | General anesthesia; about 60 minutes; usually home the same day, sometimes one night | You wake with a catheter and usually keep it for a short time at home. Mild burning and urgency for several weeks are common. | Less risk of ejaculatory problems |
| TURP | An electric loop passed through the urethra cuts away excess tissue. A long-standing standard with a high success rate. | General anesthesia; about 60 minutes; overnight stay | Usually a catheter for a short time after surgery. | Higher chance of retrograde ejaculation |
| Robotic simple prostatectomy | Through small incisions in the abdomen, removes the inside of the prostate but not the whole gland (the orange, not the peel). Well suited to large prostates, over 100 grams. | General anesthesia; overnight stay | Catheter for about 1 week. | Retrograde ejaculation is common |
You can read more on the enlarged prostate page and the Aquablation page.
The bottom line: there is no single right procedure for every man. The choice depends on the size and shape of your prostate, which imaging and a cystoscopy show, and on what matters most to you. That is a conversation to have in person.
So which one is right for me?
Your prostate’s size and shape narrow the list first. Your priorities narrow it further. A few examples of how that can play out:
- A man with a small to medium prostate who wants to protect ejaculation and recover quickly may lean toward UroLift or Rezūm, accepting that relief may be more modest or less lasting.
- A man with a larger prostate, or one with an unusual shape, may be a good fit for Aquablation.
- A man with a very large prostate may do well with a robotic simple prostatectomy.
- A man who wants relief with a long track record and is less concerned about ejaculation may choose TURP.
These are only examples. Dr. Su goes through your test results with you, explains which options fit your anatomy, and helps you weigh them against what you care about. If you are having surgery, the pre-operative instructions explain how to get ready.
One more point: a BPH procedure treats urinary symptoms. It does not treat or prevent prostate cancer, so keep up with any PSA testing you and your doctor have planned. If your PSA has been high, read what happens after a high PSA.
Questions patients ask
Will a prostate procedure affect my erections?
New erection problems are uncommon after most BPH procedures, but they are possible. Ask Dr. Su about your own risk, especially if you already have some difficulty with erections.
Can I just stay on medicine?
Yes, if the medicine controls your symptoms and the side effects are acceptable. Keep up with regular checkups, because some men develop problems such as retention or infections even while on medicine.
Will I need another procedure later?
Possibly. The prostate can keep growing over the years. Less invasive options are more likely to need a repeat or different procedure later than surgeries that remove more tissue.
What if I take a blood thinner?
Tell Dr. Su at your first visit. Some procedures cause less bleeding than others, and that can affect the choice. Do not stop a blood thinner on your own; your primary care doctor or cardiologist will advise you on when to stop it before a procedure.
If you’d like Dr. Su to look at your results, book a visit or call the office nearest you. Bring any PSA results, urine tests and prostate imaging you already have.