Understanding enlarged prostate — symptoms, treatments, and surgical options including HoLEP and ThuLEP
BPH is non-cancerous enlargement of the prostate gland affecting men over 50. The growing prostate compresses the urethra, obstructing urine flow. By age 70, over 70% of men have BPH to some degree.
Weak stream, nocturia (night urination), hesitancy, incomplete emptying, urgency, and in severe cases urinary retention requiring catheterization. Severity is scored with the IPSS questionnaire.
Seek help if symptoms affect sleep or daily life, if you notice blood in urine, pain urinating, complete urinary retention, or recurrent UTIs. Early treatment prevents bladder damage and kidney problems.
Digital rectal exam, PSA blood test (to exclude cancer), uroflowmetry, post-void residual ultrasound, and sometimes urodynamic studies. Prostate size is measured by transrectal or abdominal ultrasound.
Alpha-blockers (tamsulosin, alfuzosin) relax prostate muscle for quick relief. 5-alpha reductase inhibitors (finasteride, dutasteride) shrink the gland over months. Tadalafil treats BPH and erectile dysfunction simultaneously.
Have more questions? Book a consultation with Dr. Samer Morsy
Laser enucleation (HoLEP/ThuLEP/BipolLEP) removes the entire obstructing adenoma endoscopically. TURP is the traditional gold standard. Minimally invasive options: Rezūm (water vapor) and UroLift for smaller prostates.
Laser enucleation has lower bleeding risk (safe on blood thinners), 1-2 day hospital stay, faster recovery, and far lower retreatment rates. Considered superior to TURP for medium and large prostates.
Most patients go home in 24-48 hours with a catheter for 1-2 days. Temporary urgency or mild leakage may occur for 2-6 weeks. Full activity in 2-4 weeks. Results are durable long-term.
Retrograde ejaculation (semen enters bladder) occurs in 50-90% — expected and harmless. Erectile function is generally preserved or improves. Risk of true erectile dysfunction from surgery alone is very low.
PSA at 6 months then annually. Uroflowmetry at 3 months. Annual bladder ultrasound. Limit caffeine and alcohol, timed voiding, and pelvic floor exercises support long-term bladder health.
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