BPH Treatment Comparison: Pros & Cons

Foundational Information About Treating BPH

Benign prostatic hyperplasia (BPH) refers to excessive growth of the prostate gland. You may also hear this condition called an enlarged prostate.

It’s normal for the prostate to continue to grow as men age. However, excessive growth can cause discomfort and a variety of urinary issues. BPH is generally not life-threatening. Instead, it is known for disrupting daily life and bothersome symptoms.

A variety of proven BPH treatment options are available to treat the symptoms of this condition. Learning more about them can help you better understand your options for addressing BPH.

Which BPH Treatment is Right for You?

Active treatment options for benign prostatic hyperplasia range from pharmaceuticals to surgery. Initially, most patients will start treatment for BPH by taking a medication such as Flomax or Finasteride.

Flomax helps to relax the tissue in the prostate. Finasteride blocks the body’s production of a version of testosterone that causes the prostate to enlarge. While often effective and non-invasive, both of these medications can have significant side effects.

What happens if you cannot or do not want to tolerate the side effects of BPH medications, or if they are not effective? There are other treatment options for BPH to consider.

Traditional procedures to treat BPH include options like a transurethral resection of the prostate (TURP). However, this approach is invasive and often results in significant blood loss.

Newer, more minimally invasive procedures are now available with a lower risk of side effects. While not appropriate for all instances of BPH, such options can offer many potential benefits compared to older treatments.

These effective and novel procedures include laser focal therapy (LFT), also called focal laser ablation (FLA), and transurethral ultrasound ablation (TULSA-PRO).

Review the BPH treatment comparison table below to learn more.

Every man is different, and so are their prostate concerns. Having access to a variety of minimally invasive treatment options means more paths to move forward in addressing BPH.

It’s always best to do your research and talk with your physician to find a treatment that’s right for you. However, reading about common BPH treatment options can help prepare you to make a more informed decision as you consult with your physician.

Comparing Treatment Options for Benign Prostatic Hyperplasia

 Laser Focal TherapyTULSA-PRO®TURP/GreenLightUroLiftRezum
Minimally invasiveIcon CheckmarkIcon CheckmarkIcon X Icon CheckmarkIcon Checkmark
Low blood lossIcon CheckmarkIcon CheckmarkIcon X 1, 2 Icon CheckmarkIcon Checkmark
Relatively low risk of retrograde ejaculationIcon CheckmarkIcon CheckmarkIcon X Icon Checkmark 3Icon Checkmark 4
Get to keep the prostatic urethraIcon CheckmarkIcon CheckmarkIcon X Icon CheckmarkIcon Checkmark
Requires general anesthesiaIcon XIcon CheckmarkIcon Checkmark Icon XIcon X
Results in the removal of excess tissueIcon CheckmarkIcon CheckmarkIcon Checkmark Icon XIcon Checkmark
Requires a surgical device to be inserted into the penisIcon XIcon CheckmarkIcon Checkmark Icon CheckmarkIcon Checkmark
Real time image guidance during ablationIcon CheckmarkIcon CheckmarkN/A N/AIcon X
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[1] Descazeaud, A., Azzousi, A.R., Ballereau, C. et al. (2010). Blood loss during transurethral resection of the prostate as measured by the chromium-51 method. National Library of Medicine, 24(11), 1813-1816. doi: 10.1089

[2] Bruyère F, Huglo D, Challacombe B, Haillot O, Valat C, Brichart N. Blood loss comparison during transurethral resection of prostate and high power GreenLight(™) laser therapy using isotopic measure of red blood cells volume. J Endourol. 2011 Oct;25(10):1655-9. doi: 10.1089/end.2011.0104. Epub 2011 Aug 11. PMID: 21834657.

3 Preserving ejaculatory function in young patients with lower urinary tract symptoms: medium- to long-term follow-up of prostatic urethral lift at a single center https://pubmed.ncbi.nlm.nih.gov/34377154/

4 Rezūm Water Vapor Thermal Therapy for Lower Urinary Tract Symptoms Associated With Benign Prostatic Hyperplasia: 4-Year Results From Randomized Controlled Study https://pubmed.ncbi.nlm.nih.gov/30677455/

Treating BPH

There are four main options for treating benign prostatic hyperplasia (BPH). They support patients across the spectrum, from those with mild diagnoses suggesting no intervention to patients with significant, multiple symptoms requiring medication or surgery.
If your symptoms are mild or you’re not bothered by the effects of BPH, you and your doctor may choose to watch, monitor, and wait. A yearly exam is common. Personal awareness of any change in urination can be crucial to the success of this BPH treatment option..

BPH is usually treated first with a medication called an alpha-blocker (e.g., Flomax, alfuzosin, Rapaflo). These medications help to relax the muscles in the prostate, taking some of the pressure off the urethra. Unfortunately, these medications often have side effects, including dizziness, decreased energy, and/or retrograde ejaculation.

Another class of medications is 5α-reductase inhibitors (e.g., finasteride or dutasteride). These medications block the body’s production of a version of testosterone that causes the prostate to enlarge. As a result, they can also decrease erectile function, energy, and libido.

If side effects are too extreme, the medication is not effective, or too much bladder damage is occuring, surgical BPH treatment options are often the next step.

Transurethral Incision of the Prostate (TUIP)

The surgeon makes small cuts in the bladder neck, where the urethra joins the bladder and in the prostate. This widens the urethra and reduces the pressure of the prostate on the urethra, making urination easier. The hospital stay is often one-to-three days. A catheter is left in the bladder for one-to-three days after surgery.

Photoselective Vaporization (PVP)

PVP (such as GreenLight laser) is a way to vaporize prostate tissue with a high-powered laser. It is typically an outpatient procedure performed. The procedure takes place at the hospital or sometimes in the doctor’s office. The high power laser is inserted into the penis and advanced to the prostate. It then literally vaporizes part of the urethra in the prostate and continues vaporizing part of the prostate itself. This is an invasive procedure, and there are commonly some side effects. Also, PVP is not recommended for men with the largest prostates.

Transurethral Resection of the Prostate (TURP)

A common surgery for men with BPH, the device is inserted into the penis and advanced to the prostate. The doctor then uses an electrical knife to cut through part of the urethra in the prostate and part of the prostate itself. Men with moderate-to-severe BPH symptoms may be good candidates for TURP. There is commonly a lot of blood loss with this procedure, and there is a maximum prostate size limit.

Simple Prostatectomy

The entire prostate gland is removed via laparoscopic or robotic-assisted surgery. This treatment is generally only offered to men with very large prostate glands.

For those with BPH, laser focal therapy (LFT) / focal laser ablation (FLA) or transurethral ultrasound ablation (TULSA-PRO) may be worth considering.

After using an MRI to map the prostate gland, the physician targets the areas of enlargement. Those areas are then destroyed with a laser (LFT/FLA) or ultrasound (TULSA-PRO). Real-time MRI guidance and temperature mapping help to provide a safer patient experience and more positive results.

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