There are several minimally-invasive options available to treat an enlarged prostate. All are effective, but each has slightly different benefits and potential side effects. The best treatment for you depends on the size of your prostate, your symptoms, and your personal preferences.

1. Transurethral Resection of the Prostate (TURP)

TURP is one of the most commonly performed procedures for BPH and is considered the gold standard. A thin tube called a resectoscope is inserted through the urethra to remove excess prostate tissue. TURP is very effective, but very large prostates may require alternative procedures such as HoLEP or robotic simple prostatectomy.

2. Transurethral Incision of the Prostate (TUIP)

TUIP involves making small incisions in the prostate to widen the urinary channel. This procedure is usually suitable for men with smaller prostates and generally has fewer side effects than TURP.

3. Laser Surgery

Laser procedures use high-energy light to remove or vaporize excess prostate tissue. Common techniques include:

• HoLEP (Holmium Laser Enucleation of the Prostate): Removes enlarged tissue.

• GreenLight Laser Therapy: Vaporizes excess tissue.

Both laser options usually result in less bleeding and a shorter hospital stay compared with TURP.

4. Robotic Simple Prostatectomy

This procedure uses the da Vinci Surgical System to remove the enlarged portion of the prostate. It is typically reserved for men with very large prostates that are not suitable for TURP, HoLEP, or GreenLight. Note that this is different from robotic radical prostatectomy, which is performed for prostate cancer.

5. Rezum Therapy

Rezum is a minimally-invasive, steam-based treatment. Steam injections are delivered directly into the prostate, causing the tissue to shrink and opening the urinary channel. Rezum is usually quick to perform and suitable for most men, provided the prostate is not excessively large.

Before undergoing surgery for an enlarged prostate, you will have a thorough preoperative assessment to ensure the procedure is safe and tailored to your needs.

This may include:

• Medical history and examination: Dr. Farag will review your urinary symptoms, overall health, and any previous surgeries.

• Blood tests: To check general health, kidney function, and blood count.

• Urine tests: To check for infection.

• Imaging or other tests: Occasionally, an ultrasound or other imaging may be performed to assess the size and shape of the prostate and bladder.

• Pre-anaesthetic assessment: You will meet the anaesthetist to ensure you are fit for the procedure and discuss anaesthetic options.

• Medication review: Some medications, such as blood thinners, may need to be adjusted before surgery.

On the day of your prostate surgery, you will arrive at the hospital a few hours before your scheduled procedure. After check-in, the nursing team will take you to your room and complete routine preoperative checks.

You will meet Dr.Farag and your anaesthetist, who will confirm the procedure, answer any final questions, and explain what to expect. A small intravenous line (drip) will be placed. You will then be taken to the operating theatre and may be given a general anaesthetic or a spinal anaesthetic, so you will be comfortable throughout the procedure. You can discuss this with your anaesthetist on the day.

The surgery is usually performed using a minimally invasive technique (such as TURP, laser therapy, or robotic simple prostatectomy, depending on your case). Dr.Farag removes or reduces excess prostate tissue to improve urine flow.

After the procedure, you will wake up in the recovery area, where your vital signs and comfort will be closely monitored. You may have a urinary catheter in place temporarily and, in some cases, a small drain near the surgical site. Pain is generally well controlled with medication. You will be encouraged to start moving and drinking fluids as soon as it is safe.

Your surgical team will review your progress, explain how the procedure went, and guide you through the next steps in your recovery.

Recovery after surgery for an enlarged prostate varies depending on the procedure, but most men experience steady improvement over a few weeks.

Hospital Stay:

• Most patients stay 1–3 nights in hospital, depending on the type of procedure and recovery progress.

• You will usually have a urinary catheter in place for a few days to help your bladder heal. Nursing staff will show you how to care for it.

Urinary Symptoms:

• You may notice burning, urgency, or mild leakage after catheter removal. This is common and usually improves over time.

• Drinking plenty of water helps keep the bladder clear and reduces irritation.

Activity and Recovery:

• Walking and light activity are encouraged as soon as you feel able.

• Returning to work is generally possible within 1–3 weeks for light duties.

• Avoid heavy lifting or strenuous activity for 4–6 weeks.

• Driving is usually safe once you are comfortable, no longer taking strong pain medication, and able to respond quickly in an emergency.

Pain Relief:

• Most men manage pain with paracetamol or anti-inflammatory medication.

• Constipation is common after surgery; a high-fibre diet, fluids, and laxatives are recommended.

Sexual Function:

• Temporary erectile changes are common, especially after larger surgeries like robotic simple prostatectomy. Most men recover function gradually over time.

When to Seek Help:
Contact your doctor promptly or go to the Emergency Department if you experience:

• Inability to pass urine

• Heavy bleeding or large clots in urine

• High fever or severe chills

• Catheter dislodgement

• Severe abdominal or pelvic pain

All surgical treatments for BPH, including TURP, laser procedures, Rezum, and robotic simple prostatectomy, can have side effects.

The likelihood and severity of these side effects vary depending on the procedure and individual factors.

Common or Mild Side Effects

• Mild burning when passing urine for a few days or weeks

• Blood in the urine for a few days after the procedure

• Temporary urgency or frequency of urination, which usually improves over several weeks (60–70% of men see improvement)

Less Common Risks (<5%)

• Delayed bleeding that may require another procedure to remove clots

• Bladder infection requiring antibiotics

• Long-term urine leakage or stress incontinence

• Unable to empty the bladder despite surgery

• Urethral stricture (scar tissue in the urethra requiring dilatation)

Rare Risks (<2%)

• Weaker erections or erectile dysfunction

• Damage to the bladder or ureters

• TUR syndrome (fluid absorption causing dilution of body salts)

• Major anaesthetic or cardiovascular complications

Very Common Side Effects

• Retrograde ejaculation (dry orgasm): occurs in 80–100% of men after TURP

Procedure-Specific Considerations

HoLEP (Holmium Laser Enucleation of the Prostate)

• Advantages:

  • Less bleeding than TURP

  • Suitable for larger prostates

  • No risk of TUR syndrome

• Disadvantages:

  • Slightly higher risk of stress incontinence

  • Longer procedure time

  • Similar risk of erectile dysfunction and retrograde ejaculation

GreenLight Laser Therapy

• Advantages:

  • Reduced bleeding compared to TURP

  • Suitable for men on blood thinners (e.g., warfarin, apixaban)

• Disadvantages:

  • No tissue available for histology

  • Higher rates of burning, urgency, and frequency

  • Similar risk of erectile dysfunction and retrograde ejaculation

Rezum Therapy

• Advantages:

  • Quick procedure (15–20 minutes)

  • Often performed as a day procedure

  • Lower risk of erectile dysfunction and retrograde ejaculation

  • Reduced bleeding risk

• Disadvantages:

  • Less durable than TURP, higher chance of needing repeat treatment

  • Catheter may be required for up to one week

Robotic Simple Prostatectomy

• Advantages:

  • Effective for very large prostates

  • Reduced urgency, frequency, scarring, and fibrosis compared with HoLEP

• Disadvantages:

  • Only suitable for very large prostates

You will have a follow-up appointment with Dr.Farag to remove the catheter, review recovery, and discuss the results of surgery. This usually occurs within 4 weeks of the surgery.

Long-term follow-up may include urine tests, PSA (if indicated), and monitoring of symptoms.