When medicines are not enough or complications occur, prostate surgery is discussed. There are many techniques today, and no single best operation for everyone; the choice depends on prostate size and shape, the patient’s health and whether preserving ejaculation matters. This is a simple comparison based on European guidelines.
Medically reviewed by Prof. Dr. Samir Ahmed Al-Samarrai, consultant urologist. Last reviewed:
When is surgery discussed?
- Repeated urinary retention.
- Repeated urinary infections or bladder stones caused by enlargement.
- Repeated bleeding from the prostate.
- Kidneys affected by obstruction.
- No improvement with, or intolerance of, medicines, or the patient’s preference after the options are explained.
Comparing the techniques
| Technique | How it works | Usually suits | Notes |
|---|---|---|---|
| Transurethral resection of the prostate (TURP) | Cuts away enlarged tissue from inside | Medium prostates (about 30 to 80 ml) | The established standard for decades; retrograde ejaculation is common |
| Laser enucleation (HoLEP and similar) | Separates the whole enlarged part, then removes it | All sizes, including very large | Less bleeding and fewer re-operations; retrograde ejaculation is common |
| Laser vaporisation | Vaporises the enlarged tissue | Medium prostates, and selected men on blood thinners | Little bleeding |
| Water vapour therapy (Rezum) | Steam injections shrink the tissue gradually | Medium prostates in men who want to preserve ejaculation | Improvement over weeks; a temporary catheter may be needed |
| Prostatic urethral lift (Urolift) | Small implants hold the urethra open | Small to medium prostates without a middle lobe | Preserves ejaculation; less improvement than resection |
| Simple prostatectomy (open, laparoscopic or robotic) | Removes the enlarged part through the abdomen | Very large prostates when laser enucleation is not available | Longer recovery |
What to expect afterwards
- Burning and some blood in the urine for days or weeks.
- A urinary catheter for a time that depends on the technique.
- Avoiding heavy exertion for a period your doctor advises.
- Retrograde ejaculation after many techniques, usually without affecting erections. Read how BPH and its treatment affect erections and fertility.
- See your doctor urgently for heavy bleeding with clots, inability to pass urine, or fever.
How to choose
Ask your doctor about prostate size and any middle lobe, your flow test and residual urine, your medicines (especially blood thinners), whether you want children or to preserve ejaculation, and re-operation rates for each technique. The doctor decides the right technique with you after this assessment.
Related topics
Frequently asked questions
Is prostate surgery dangerous?
BPH operations are common, and serious complications are uncommon. Usual effects include burning and blood in the urine for a short time, and retrograde ejaculation after many techniques. The doctor explains the risks for your case and general health.
What is the difference between TURP and laser prostate surgery?
TURP cuts away prostate tissue from inside through the urethra and is the established standard for medium-sized prostates. Laser enucleation removes the whole enlarged part and suits all sizes, including very large ones.
What is steam prostate treatment?
This is water vapour therapy (Rezum): doses of steam are injected into the prostate and the tissue shrinks over several weeks. It usually preserves ejaculation and suits selected medium-sized prostates.
How long is the hospital stay?
It depends on the technique: some are done as day cases or with one night’s stay, others need a day or more with a urinary catheter for a while.
Can the prostate grow back after surgery?
Enlargement can return years later. Re-operation rates are lower after complete laser enucleation or TURP than after some less invasive techniques.
Sources
Book a consultation
Prof. Al-Samarrai and Dr. Amer Mousa assess prostate enlargement and explain the surgical options that suit your case at Prof. Al-Samarrai Medical Center, Dubai Healthcare City, and discuss the options that suit your case. Medical consultations are confidential.
This information is for health education and does not replace a medical examination. See our medical content policy.