About this page. This is a plain English overview of the surgical options for an enlarged prostate (BPH). It does not replace medical advice from your own doctor or specialist.
For full information and references, please read the detailed page.
The aim of all the operations
All BPH operations have the same goal: to open up a clear channel through the prostate so urine can flow more easily. They mostly differ in how the obstructing tissue is removed - cutting, vaporising, or heating - and in which prostate sizes and which patients they suit best.
The main families
- TURP (Trans Urethral Resection of the Prostate). The classic operation. A telescope is passed through the urethra and small chips of prostate are cut away. Short version: TURP.
- Holmium laser. A laser is used to "shell out" the obstructing part of the prostate from inside. Suits any prostate size, including very large prostates that previously needed open surgery. Short version: holmium laser.
- Greenlight laser. A side-firing laser vaporises tissue. Useful for smaller prostates and for men on blood-thinning medication. Short version: Greenlight laser.
- Microwave therapy. Heat is delivered through a special catheter. Usually done with sedation rather than a general anaesthetic. Short version: microwave therapy.
- TUNA (radiofrequency needles). Heat is delivered through small needles into the prostate. Short version: TUNA.
- Rezum (steam therapy) and iTind. Newer minimally invasive options. See the short-version pages on Rezum and iTind.
- Open prostatectomy. Used very rarely now, only for some unusual situations such as a very large prostate alongside a big bladder stone. Short version: open prostatectomy.
How the choice is made
Dr Kooner discusses the pros and cons of each option with you. The choice depends on:
- How big your prostate is.
- Whether you take blood-thinning medication.
- How important it is to preserve normal ejaculation.
- Your overall health and how big an anaesthetic you can safely have.
- What other problems are present, such as a bladder stone or a diverticulum.
Important things to know
- All BPH operations can affect ejaculation. Many men get retrograde ejaculation, where the semen passes back into the bladder rather than out. This is not harmful but is permanent.
- All BPH operations carry the usual risks of any procedure - bleeding, infection, anaesthetic risk, and the small chance that further treatment is needed later.
- The right operation depends on your prostate, not on the brand name. Newer is not always better. The classic TURP and the holmium laser remain the standard against which others are compared.
- Surgery is usually only considered after a fair trial of medication, or when there is bladder damage, bleeding, or repeated retention.
What you can do next
- Read the full detailed page with references and patient brochures.
- Short version overview of an enlarged prostate.
- Short version: non-surgical management.
- Short version: how an enlarged prostate is assessed.
- Request a second opinion on a treatment plan.
- Call 02 8382 6980 to make an appointment.