When an enlarged prostate blocks urine flow and medication isn't enough, I use two main procedures: TURP and Aquablation. Both are done through the urethra, with no incisions.

TURP

Transurethral resection of the prostate removes the blocking tissue with an electric loop through a scope. It's the longest-standing surgical treatment for an enlarged prostate and works for a wide range of sizes.

Aquablation

Aquablation uses a robotically guided, heat-free waterjet to remove prostate tissue according to a plan mapped on ultrasound. It can treat larger prostates and is designed to lower the chance of ejaculation changes.

Choosing between them

Prostate size and shape, your priorities about ejaculation, other health problems, and blood thinners all play a role. For very large prostates, robotic simple prostatectomy is another option. Office treatments such as UroLift and Rezūm suit some men with smaller prostates.

Recovery

Usually one night with a catheter for a day or two. Burning, urgency, and some blood in the urine are common for a few weeks.

Risks

Bleeding, infection, temporary urgency, dry orgasm (more common with TURP), and, rarely, leakage or scar narrowing.

When leakage continues afterward

An overactive bladder can cause urgency leakage even after the blockage is fixed, and also in men with a working artificial sphincter. It's treated separately, with medication, Botox, or nerve stimulation.

Related

TURP and Aquablation recovery · Enlarged prostate · UroLift and Rezūm