There are now more treatments for an enlarged prostate than ever. That is good news, but it can make the choice harder. No single option is best for every man. The right treatment depends on the size and shape of your prostate, your general health and what matters most to you.
Start with your priorities
Before comparing procedures, it helps to think about what you want from treatment:
- the strongest possible improvement in flow
- the shortest recovery and time off work
- protecting ejaculation and sexual function
- a long-lasting result with little chance of repeat treatment
- avoiding a general anaesthetic or a hospital stay
Most treatments involve a trade-off between some of these. Writing your priorities down in order before a consultation can make the discussion more focused, and it helps your urologist recommend the options that fit you best. The figures below are general guides; your own recovery may be quicker or slower depending on your health and the size of your prostate.
TURP
Recovery: one to three days in hospital, two to three weeks before returning to light work. Durability: long-lasting for most men. Ejaculation: retrograde ejaculation is common.
Our guide to TURP explains the operation in detail.
HoLEP laser surgery
Recovery: often one night in hospital, two to four weeks to full activity. Durability: very long-lasting, as most obstructing tissue is removed. Ejaculation: retrograde ejaculation is very common.
HoLEP is particularly suited to large prostates.
Aquablation therapy
Recovery: usually one or two nights in hospital, with a catheter for a short time. Durability: good long-term results in published studies. Ejaculation: designed to preserve ejaculation for many men, as the robotic waterjet avoids key areas.
Aquablation can treat a wide range of prostate sizes. Our article on Aquablation therapy and the HYDROS system explains how it works, and our Aquablation page covers what to expect.
iTind
Recovery: usually back to normal within days, after a device is in place for about a week. Durability: several years of benefit for many men. Ejaculation: designed to preserve ejaculation and erections.
iTind suits small to moderate prostates without a large middle lobe.
UroLift
Recovery: day case, usually back to normal within days. Durability: several years in many men, with some needing further treatment. Ejaculation: designed to preserve ejaculation and erections.
UroLift also suits small to moderate prostates.
Prostate artery embolisation
Recovery: often same day or overnight, with no surgery through the urethra. Durability: improvement may be less than with surgery, and some men need further treatment. Ejaculation: sexual function is usually preserved.
Prostate artery embolisation can suit men who want to avoid a general anaesthetic or are less fit for surgery. It is carried out by an interventional radiologist rather than a surgeon.
Quick summary
- Strongest, most durable relief: HoLEP, TURP or Aquablation.
- Best chance of preserving ejaculation: iTind, UroLift, prostate artery embolisation or Aquablation.
- Quickest recovery: iTind, UroLift or prostate artery embolisation.
- Very large prostates: HoLEP, Aquablation or prostate artery embolisation.
Other factors
Your urologist will also consider:
- whether you have had urinary retention
- whether you take blood-thinning medicines
- the strength of your bladder muscle
- any previous prostate treatment
NICE guidance on urinary symptoms in men and the British Association of Urological Surgeons both publish information on these treatments.
Talking it through
A good consultation should cover every suitable option, not just one. Bring your list of priorities and ask how each treatment fits them. It is also reasonable to ask how often your surgeon performs each procedure, as experience can affect results.
Professor Prokar Dasgupta offers a range of treatments for an enlarged prostate at The London Clinic. Please contact the clinic to discuss which suits you.