Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 23 July 2026
An enlarged prostate — benign prostatic hyperplasia, or BPH — affects roughly half of men in their sixties and the large majority by their eighties. It is not cancer, but the urinary symptoms it causes can be genuinely disruptive: broken sleep, urgency that dictates where you go, and a stream that never quite empties the bladder. The good news is that there has never been a wider range of effective treatments. This guide compares them so you can have a more informed conversation with your urologist.
Recognising the Symptoms
Lower urinary tract symptoms from BPH fall into two groups. Voiding symptoms reflect the obstruction itself: a weak or intermittent stream, hesitancy before flow starts, straining, terminal dribbling and a sense of incomplete emptying. Storage symptoms reflect how the bladder responds: frequency, urgency and nocturia (waking at night to pass urine). Storage symptoms are often the most bothersome and can take longer to settle after treatment because the bladder muscle needs time to recover.
Some symptoms warrant urgent review rather than watchful waiting: complete inability to pass urine, recurrent urinary infections, visible blood in the urine, or a rising creatinine suggesting back-pressure on the kidneys.
How BPH Is Diagnosed
Diagnosis is mostly clinical, supported by simple tests. Expect a symptom score questionnaire, a urine test to exclude infection, a PSA blood test, kidney function tests and a digital rectal examination. A urinary flow rate and a bladder scan to measure residual urine give an objective picture of how well you are emptying. Prostate size — a critical factor in choosing treatment — is estimated on ultrasound or MRI. Where the diagnosis is unclear, or where previous surgery has not worked, urodynamics and cystoscopy are used to distinguish obstruction from a poorly contracting or overactive bladder.
Lifestyle Measures and Medication
Men with mild symptoms often do well with fluid timing (reducing evening intake), moderating caffeine and alcohol, double voiding, and reviewing medications that worsen retention. When symptoms progress, alpha-blockers relax prostatic smooth muscle and work within days; 5-alpha-reductase inhibitors shrink larger prostates over six to twelve months and reduce the risk of retention and future surgery. Combination therapy is often used for glands over roughly 40 mL. Medications need to be taken indefinitely, and side effects — dizziness, retrograde ejaculation, reduced libido — are the usual reason men eventually consider a procedure.
Minimally Invasive Options
Rezum (water vapour therapy)
Rezum delivers sterile steam into the prostate; the treated tissue is reabsorbed over the following weeks. It is a short day procedure, preserves sexual function well in most men, and suits moderate-sized prostates. Symptoms improve gradually rather than immediately, and a catheter is usually needed for several days.
UroLift (prostatic urethral lift)
UroLift uses small implants to hold the obstructing lobes apart. No tissue is removed or heated, so relief is immediate and ejaculatory function is typically preserved. It is best suited to smaller prostates without a large median lobe, and re-treatment rates are higher than for HoLEP over the long term.
iTIND
iTIND places a temporary nitinol device that gently reshapes the bladder neck and prostatic urethra over five to seven days before removal, leaving no permanent implant.
Definitive Surgery: TURP and HoLEP
HoLEP enucleates the entire adenoma from the prostate capsule using a holmium laser. Because the whole obstructing tissue is removed, flow improvement is large and durable, with re-treatment rates well below those of TURP or minimally invasive options. HoLEP is size-independent — it can replace open simple prostatectomy for very large glands — and its excellent haemostasis makes it a strong option for men who cannot stop anticoagulation. TURP remains a reliable, widely available operation for small and moderate prostates.
For men whose priority is antegrade ejaculation, ejaculation-sparing HoLEP modifies the enucleation to preserve tissue at the bladder neck and around the verumontanum. A full side-by-side comparison of the two mainstream operations is available in our HoLEP vs TURP guide.
Choosing Between the Options
Three questions usually decide the recommendation. How large is the prostate? How severe is the obstruction and has the bladder already been affected? And how important is preserving ejaculation relative to achieving the biggest, most durable improvement in flow? A 40 mL prostate in a man who wants to preserve ejaculation and accepts possible re-treatment points towards UroLift or Rezum. A 150 mL prostate with retention and recurrent infections points firmly towards HoLEP.
Outcomes and What to Expect Afterwards
Most men notice a stronger stream immediately after HoLEP or TURP, though urgency and burning can persist for several weeks while the prostatic cavity heals. Night-time frequency is often the last symptom to settle, particularly where the bladder has been working against obstruction for years. Follow-up usually includes a flow rate and residual bladder scan at around three months.
Frequently Asked Questions
What is benign prostatic hyperplasia (BPH)?
BPH is a non-cancerous enlargement of the prostate gland that becomes increasingly common with age. As the prostate grows it compresses the urethra, obstructing urine flow. This causes lower urinary tract symptoms such as a weak stream, hesitancy, straining, incomplete emptying, frequency and getting up at night to pass urine. BPH is not prostate cancer and does not turn into cancer, although the two conditions can coexist.
What symptoms suggest I need treatment for an enlarged prostate?
Treatment is usually considered when symptoms interfere with sleep, work or quality of life, or when complications develop. Warning signs that warrant prompt urological review include inability to pass urine (acute retention), recurrent urinary infections, blood in the urine, bladder stones, or kidney impairment from back-pressure. Men with mild symptoms that don't bother them can often be managed with lifestyle measures and monitoring alone.
How is BPH diagnosed?
Assessment typically includes a symptom score questionnaire (IPSS), urine testing, a PSA blood test, kidney function tests, a digital rectal examination, and a bladder scan to measure how much urine remains after voiding. A urinary flow rate study is often performed. Ultrasound or MRI may be used to size the prostate, and flexible cystoscopy or urodynamics are added when the picture is unclear or previous treatment has failed.
What medications are used for an enlarged prostate?
Alpha-blockers such as tamsulosin relax the muscle in the prostate and bladder neck and typically improve symptoms within days, though they can cause dizziness and retrograde (dry) ejaculation. 5-alpha-reductase inhibitors such as dutasteride shrink larger prostates over 6-12 months and reduce the risk of retention, but may affect libido and erectile function. The two are often combined for larger glands.
What is HoLEP and who is it best for?
Holmium laser enucleation of the prostate (HoLEP) removes the entire obstructing prostate tissue from its capsule using a laser, and is considered a size-independent gold-standard operation — it works for very large glands that would otherwise need open surgery. HoLEP offers durable flow improvement with very low re-treatment rates, minimal bleeding (making it suitable for men on blood thinners) and a short catheter time.
How does HoLEP compare with TURP?
Both relieve obstruction effectively, but HoLEP removes more tissue, has lower bleeding risk, a shorter catheter and hospital stay, and a much lower long-term re-treatment rate. TURP remains an appropriate option for small to moderate prostates and is widely available. HoLEP is technically demanding and requires specific surgical training. Detailed comparison is available on the HoLEP vs TURP guide on this site.
Are there treatments that preserve ejaculation?
Yes. Minimally invasive options such as UroLift (prostatic urethral lift) and iTIND largely preserve ejaculatory function, and Rezum water vapour therapy has a comparatively low rate of ejaculatory change. Ejaculation-sparing HoLEP is a modified technique that preserves tissue around the bladder neck and verumontanum to maintain antegrade ejaculation in appropriately selected men, while still relieving obstruction.
What is Rezum, UroLift and iTIND?
These are minimally invasive day procedures for moderate BPH. Rezum injects sterile water vapour into prostate tissue, which then shrinks over 4-12 weeks. UroLift places small implants that hold the prostate lobes apart, giving immediate relief without cutting tissue. iTIND temporarily places a device that reshapes the bladder neck over five to seven days. All have faster recovery than HoLEP but generally less flow improvement and higher re-treatment rates.
What are the risks of prostate surgery for BPH?
Risks common to all BPH surgery include bleeding, urinary infection, temporary burning or urgency, and retrograde ejaculation (most likely after TURP and HoLEP). Less common problems include urethral stricture, bladder neck contracture and, rarely, stress urinary incontinence, which is usually temporary. Erectile function is generally unchanged. Your individual risk depends on prostate size, bladder function and general health.
Where can I have BPH treatment in Melbourne?
Dr Brendan Dias assesses and treats benign prostatic enlargement at consulting rooms in Maribyrnong and Bundoora, operating at affiliated Melbourne hospitals. He offers the full range of options — medical therapy, Rezum, UroLift, iTIND, ejaculation-sparing techniques and HoLEP for prostates of any size — so the recommendation can be matched to your prostate size, symptoms and priorities rather than to a single available technology.
The Bottom Line
There is no single best treatment for an enlarged prostate — only the best treatment for your prostate size, bladder function and personal priorities. If urinary symptoms are affecting your sleep or daily life, an assessment that measures flow, residual urine and prostate size will narrow the options quickly and let you choose with confidence.