Only you and your doctor can answer that question. The size of your enlarged prostate, severity of your symptoms, your desire to retain or maintain sexual function, your age, presence of other health problems, and your lifestyle are all factors to be considered. Before you make any decision, however, be sure to review all of your alternatives, talk with loved ones who may be impacted by your decision, and select a surgeon who is knowledgeable, receptive to your questions, and experienced in your chosen procedure.
As a general rule:
- Surgical procedures offer the best relief of BPH symptoms but side effects and complications are more common
- TURP and laser procedures (i.e., PVP, HoLAP, HoLEP) have similar significant improvement in urinary symptoms and long-term outcomes
- Laser procedures have fewer short-term side effects compared with TURP
- TURP results can last up to 15 years, but erectile dysfunction and retrograde ejaculation occurrence are high
- Most men can stop taking BPH medications after TUNA or TUMT
- TUNA, TUMT, and ILT are equally effective in relieving symptoms of BPH
- The options associated with the lowest occurrence of erectile dysfunction include Urolift, prostate artery embolization, HoLAP, HoLEP, and PVP
- Looking at the short-term (24 month) need for reoperation, the four more common procedures come in at 2.09% for PVP, 2.2% for TURP, 11.9% for TUMT, and 14% for TUNA.
- Stents are a short-term solution with a high complication rate and usually reserved for men who cannot or will not undergo other surgical procedures
- Prostate artery embolization is a relatively new procedure that has provided good symptom relief, offered no problems with erectile dysfunction, incontinence, or retrograde ejaculation, but is still under investigation and not widely available
- Urolift System has a low retreatment rate, no occurrence of erectile dysfunction and retrograde ejaculation, and good symptom relief, but it is relatively new and needs long-term studies. At this time, not all Medicare carriers cover this treatment.
- BPH symptom relief is similar between TURP and TUIP, but men who choose TUIP are more likely to need a repeat procedure yet less likely to experience retrograde ejaculation.
Related: Comparing Treatments For BPH