Enlarged Prostate (BPH) Treatment & Surgery
Waking three times a night, a weak stream, and never quite emptying — an enlarged prostate is not cancer, and it is very treatable. Our urologists start with medication where it will work and offer laser enucleation or TURP where it will not. Most men are catheter-free within 48 hours and back to routine in two weeks.
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What is Enlarged Prostate?
Benign prostatic hyperplasia, or BPH, is enlargement of the prostate gland that happens to most men as they age. The first thing to say clearly, because it is the question behind almost every consultation: BPH is not cancer, and it does not turn into cancer. They are different diseases that happen to affect the same organ, and a man can have either, both or neither.
The prostate sits directly beneath the bladder and the urethra — the tube carrying urine out — runs straight through the middle of it. That anatomy explains every symptom. As the gland enlarges, it squeezes the urethra like a hand closing around a hosepipe. The bladder has to generate more pressure to push urine through, and over years the bladder muscle thickens and becomes irritable in response. This is why the symptoms come in two groups: obstructive symptoms from the narrowing (weak stream, hesitancy, straining, dribbling, incomplete emptying) and storage symptoms from the overworked bladder (urgency, frequency, and getting up at night).
Prostate size and symptom severity correlate surprisingly poorly. A man with a modestly enlarged gland can have severe symptoms if the enlargement is in the wrong place; another with a very large prostate may barely notice. This is why treatment is guided by how much the symptoms affect your life — measured with a standard questionnaire, the IPSS — rather than by the number on the ultrasound report.
Most men do not need surgery. Mild symptoms often respond to simple changes: not drinking fluids in the two hours before bed, cutting evening caffeine and alcohol, and double voiding. Beyond that, medication works well for the majority — alpha blockers relax the muscle in the prostate and bladder neck and act within days, while 5-alpha reductase inhibitors actually shrink the gland over three to six months.
Surgery becomes the right answer when medication fails or is not tolerated, and it becomes necessary in specific situations: retention of urine needing a catheter, recurrent urinary infections, bladder stones, blood in the urine from the prostate, or kidney impairment from back-pressure. Those are not symptoms to manage — they are reasons to operate, because leaving them risks permanent bladder or kidney damage.
One thing to know before consenting to any prostate operation: retrograde ejaculation is common afterwards. Semen passes backwards into the bladder instead of forwards, so orgasm feels normal but there is little or no ejaculate. It is harmless and does not affect erections, but it does affect fertility, and it should be discussed openly before surgery rather than discovered after it.
Treatment information
| Condition | Benign Prostatic Hyperplasia (BPH) |
|---|---|
| Procedure | TURP / HoLEP Laser Prostate Surgery |
| Duration | 60 to 120 minutes |
| Treated by | Urologist |
| Anaesthesia | Spinal anaesthesia, occasionally general |
| Success rate | 90–95% |
| Recovery time | 2 to 4 weeks |
| Hospital stay | 1 to 3 days |
Signs you may need Enlarged Prostate treatment
- Getting up two or more times at night to pass urine (nocturia)
- A weak or slow urinary stream
- Hesitancy — waiting for the stream to start
- Straining to pass urine
- A stream that starts and stops
- Dribbling at the end of urination
- A feeling that the bladder has not emptied completely
- Sudden urgency, sometimes with leakage before reaching a toilet
- Passing urine frequently through the day
- Recurrent urinary tract infections
- Blood in the urine
- Complete inability to pass urine — acute retention, which is a medical emergency
What causes it?
- Age-related hormonal change, particularly the effect of dihydrotestosterone on prostate tissue
- Growth of the transition zone of the prostate, which surrounds the urethra
- A shifting balance between testosterone and oestrogen with age
- Secondary thickening and irritability of the bladder muscle from long-term obstruction
- Genetic factors — BPH needing treatment runs in families
Who is more likely to be affected
- Age above 50 — the single strongest factor, with prevalence rising each decade
- A father or brother who needed treatment for BPH
- Obesity and a large waist circumference
- Type 2 diabetes
- Heart disease and the metabolic syndrome
- A sedentary lifestyle
- Erectile dysfunction, which frequently coexists
When to see a doctor immediately
- Getting up more than once a night to pass urine, if it is disturbing your sleep
- A urinary stream that is noticeably weaker than it used to be
- Straining, hesitancy or dribbling
- A persistent feeling of incomplete emptying
- Two or more urinary infections in a year
- Blood in the urine — always needs assessment
- Pain or burning on passing urine
- Complete inability to pass urine with a painful, full bladder — go to hospital immediately
- Any of these symptoms alongside back pain, weight loss or bone pain, which need urgent assessment
How it is diagnosed
IPSS symptom score
A standard eight-question score that quantifies how badly the symptoms affect you and grades them mild, moderate or severe. It is the main driver of the treatment decision, and repeating it later is how response to treatment is measured objectively rather than by impression.
Digital rectal examination
A brief examination assessing the size, shape and consistency of the prostate. A smooth, firm, symmetrically enlarged gland suggests BPH; a hard, irregular or nodular gland raises the possibility of cancer and prompts further investigation.
PSA blood test
Prostate-specific antigen is raised by BPH as well as by cancer, by infection and even by recent catheterisation or cycling — so it is interpreted alongside the examination and your age rather than read as a cancer test on its own. A markedly raised or rapidly rising PSA leads to MRI and possibly biopsy.
Uroflowmetry and post-void residual
You pass urine into a machine that measures the flow rate, then an ultrasound measures how much is left behind. Together these objectively confirm obstruction and quantify how poorly the bladder is emptying — which is often the deciding factor for surgery.
Ultrasound of the kidneys, ureters, bladder and prostate
Measures prostate volume, checks the bladder wall for thickening, looks for stones, and — importantly — examines the kidneys for back-pressure. Hydronephrosis from chronic obstruction changes the urgency of treatment entirely.
Urine analysis and culture
Excludes infection, which can mimic or worsen BPH symptoms, and detects blood or sugar in the urine that would point to another diagnosis.
Urodynamic studies
Reserved for complex cases — younger men, those with neurological disease, or where it is unclear whether the problem is obstruction or a poorly contracting bladder. This distinction matters, because surgery relieves obstruction but does nothing for a weak bladder muscle.
How the options compare
| Feature | TURP (Transurethral Resection) | HoLEP / Laser Enucleation |
|---|---|---|
| Technique | Tissue shaved away in chips with an electric loop | Whole lobes enucleated off the capsule with a laser |
| Best for prostate size | Up to about 80 g | Any size, including very large glands |
| Bleeding | More | Markedly less |
| Safe on blood thinners | Often needs them stopped | Usually feasible |
| Catheter time | 2–3 days | 1–2 days |
| Hospital stay | 2–3 days | 1–2 days |
| Tissue for histopathology | Yes | Yes |
| Retreatment rate | Higher over 10 years | Lower |
| Cost | Lower | Higher |
| Availability | Widely available | Needs specific equipment and training |
Types of treatment
Lifestyle measures
Fluid timing
Stopping fluids two to three hours before bed alone reduces night-time waking substantially for many men. Total daily intake stays the same — it is the timing that changes.
Reducing caffeine and alcohol
Both are diuretics and both irritate the bladder. Cutting them in the evening often makes a noticeable difference to urgency and nocturia within a week.
Double voiding and bladder training
Waiting a few moments after passing urine and going again empties the bladder more completely. Timed voiding retrains an overactive bladder and reduces urgency.
Reviewing your other medicines
Decongestants, some antihistamines and certain antidepressants all worsen urinary retention. A medication review sometimes resolves a substantial part of the problem without adding anything new.
Medication
Alpha blockers
Tamsulosin, silodosin and alfuzosin relax smooth muscle in the prostate and bladder neck, improving flow within days. The commonest first-line treatment. Side effects include dizziness on standing and retrograde ejaculation, and they need to be declared to your eye surgeon before any cataract operation.
5-alpha reductase inhibitors
Finasteride and dutasteride shrink the gland by around a quarter over three to six months, and reduce the long-term risk of retention and the need for surgery. They work slowly, they halve the PSA reading — which must be accounted for in interpretation — and they can affect libido and erectile function.
Combination therapy
An alpha blocker with a 5-alpha reductase inhibitor gives faster relief plus long-term gland shrinkage. The standard approach for men with larger prostates and moderate to severe symptoms.
Tadalafil
A daily low dose improves both urinary symptoms and erectile function, which makes it a sensible choice for men who have both.
Anticholinergics or beta-3 agonists
Added where storage symptoms — urgency and frequency — persist despite good flow. Used carefully, with residual volume monitored, since they can worsen incomplete emptying.
Surgical treatment
TURP — transurethral resection of the prostate
The long-standing benchmark operation. Passing an instrument through the urethra, the obstructing tissue is shaved away in small chips with an electrical loop. No external incision. Highly effective, well studied, and widely available.
Bipolar TURP
A refinement using saline irrigation rather than glycine, which removes the risk of TUR syndrome — the fluid absorption complication of the older monopolar technique. Bleeding is also usually less.
HoLEP / ThuLEP laser enucleation
The laser peels the whole obstructing lobes off the prostate capsule, like separating an orange from its peel, and the tissue is then morcellated and removed. Suits prostates of any size, bleeds far less, allows a shorter catheter time, and has a lower rate of needing repeat surgery.
Laser vaporisation (GreenLight)
Obstructing tissue is vaporised rather than cut out. Very low bleeding risk, which makes it useful for men who cannot stop blood thinners — though no tissue is retrieved for histopathology.
Prostatic urethral lift (UroLift)
Small implants hold the prostate lobes apart without cutting or removing tissue. Its main appeal is preserving ejaculatory function, but it suits only selected prostate shapes and gives less improvement in flow than resection.
Open or laparoscopic simple prostatectomy
Reserved for very large prostates where endoscopic surgery is not feasible. Increasingly uncommon in centres that offer laser enucleation, which handles large glands without an incision.
What happens, step by step
- 1
Consultation and assessment
40–60 minutes- IPSS symptom score completed and discussed
- Digital rectal examination and PSA reviewed together
- Uroflowmetry and post-void residual measured
- Ultrasound assesses prostate volume, bladder wall and kidneys
- Retrograde ejaculation and its implications explained before consent
- 2
Pre-operative preparation
1–3 days- Blood counts, sugar, kidney function, clotting and ECG
- Urine culture — an active infection must be treated before surgery
- Blood thinners reviewed and adjusted with your cardiologist where needed
- Anaesthetic assessment; spinal anaesthesia is usual
- 3
The operation
60–120 minutes- Spinal anaesthesia is given — you are awake but numb from the waist down
- A telescope is passed along the urethra; there is no external cut anywhere
- Obstructing tissue is resected, enucleated or vaporised depending on the technique
- The prostatic cavity is inspected and bleeding points sealed
- Removed tissue is sent for histopathology
- A three-way catheter is placed to irrigate the bladder and keep it clear
- 4
Recovery and catheter removal
1–3 days- Continuous bladder irrigation runs for the first 12 to 24 hours
- You walk and eat normally the same evening
- Blood-stained urine is expected and clears progressively
- The catheter comes out at 24 to 72 hours depending on the technique
- Discharge once you are passing urine satisfactorily on your own
How to prepare
- Bring a list of every medicine you take, including anything from a cardiologist
- Discuss blood thinners early — they may need adjusting, and laser techniques are often safer if they cannot be stopped
- Treat any urinary infection fully before surgery; operating through infection risks sepsis
- Complete blood tests, ECG and anaesthetic assessment
- Fast for six to eight hours before the procedure
- Ask about retrograde ejaculation before you consent, not after
- Arrange an adult to bring you home; you will not be able to drive for a week or two
- Plan for a week of light activity at home after discharge
Why patients choose this procedure
The stream improves markedly
Flow rates typically double after surgery, and the straining, hesitancy and stop-start pattern resolve for the great majority of men.
Sleep returns
Reducing night-time waking is often the change men value most. The effect on daytime energy and mood is substantial and frequently underestimated.
The bladder empties properly
Clearing the obstruction removes the residual urine that causes recurrent infections, bladder stones and, eventually, back-pressure on the kidneys.
No external incision
Everything is done through the urethra. There is no cut on the abdomen and no external wound to care for.
Durable result
Most men need no further prostate treatment for a decade or more, and laser enucleation has a lower retreatment rate still.
Freedom from daily medication
Many men stop their prostate tablets entirely after surgery, along with the dizziness or sexual side effects those tablets were causing.
Possible risks and side effects
Retrograde ejaculation
Common — affecting most men after TURP or laser enucleation. Semen passes backwards into the bladder, so orgasm feels normal but there is little or no ejaculate. It is harmless and does not affect erections, but it does affect fertility. Anyone still planning to father children should raise this before consenting.
Blood in the urine
Expected for days to a few weeks, and it often flares briefly around week two when the scab in the prostatic cavity separates. Increasing fluids usually clears it; heavy bleeding with clots needs review.
Urinary infection
Reasonably common in the weeks after surgery, particularly while a catheter is in place. Treated with antibiotics after a urine culture.
Temporary urgency and burning
The raw prostatic cavity takes six to twelve weeks to heal, and until it does, urgency and burning are common. This is healing rather than failure, though it frustrates men who expected instant improvement.
Urinary incontinence
Mild stress leakage is fairly common in the first weeks and improves with pelvic floor exercises. Persistent incontinence is uncommon and reflects injury to the external sphincter.
Urethral stricture or bladder neck contracture
Scarring in the urethra or at the bladder neck can narrow it months to years later, causing the stream to deteriorate again. Usually treatable endoscopically.
Erectile dysfunction
Less common than patients fear, and rates are similar to those in men of the same age who have not had surgery. It should still be discussed honestly beforehand rather than dismissed.
TUR syndrome
Absorption of irrigation fluid during long monopolar resections, causing dangerous dilution of blood sodium. Essentially eliminated by bipolar and laser techniques, which use saline irrigation.
What recovery looks like
Recovery after prostate surgery is straightforward, but it needs one expectation set correctly at the start: the improvement in flow is usually immediate, while the urgency and burning take six to twelve weeks to settle, because the prostatic cavity has to heal over from the inside. Men who are told this in advance cope with it easily; men who are not often worry that the operation failed.
Days 0 to 2: a catheter drains the bladder with continuous irrigation to keep it clear of clots. You walk and eat normally the same evening. Urine is blood-stained and clears progressively. The catheter comes out at 24 to 72 hours depending on the technique used, and you are discharged once you are passing urine satisfactorily.
Week 1: expect frequency, urgency and burning. Drink two to three litres of water a day — dilute urine irritates the healing cavity far less than concentrated urine. Walk regularly but avoid lifting anything heavy. No driving.
Week 2: a flare of bleeding around day 10 to 14 is common and expected, as the scab in the prostatic cavity separates. Increase fluids and rest; contact your coordinator if you pass clots or the urine becomes deep red. Most men with desk jobs return to work at the end of this week or during week three.
Weeks 3 to 6: symptoms settle steadily. Start pelvic floor exercises if you have any leakage. Avoid heavy lifting, cycling and strenuous exercise until six weeks. Sexual activity usually resumes at four weeks, on your surgeon's advice.
Weeks 6 to 12: the cavity is healed and the final result is apparent. A repeat flow rate and IPSS score at follow-up measure the improvement objectively, and your histopathology report is reviewed with you.
Contact your care coordinator immediately if you cannot pass urine at all, if you pass heavy clots, or if you develop fever with chills, severe pain, or urine that has become thick and dark red.
What to eat and what to avoid
Recommended
- 2 to 3 litres of water daily — dilute urine irritates the healing prostate far less
- High-fibre foods to prevent constipation, since straining causes bleeding after prostate surgery
- Cooked tomatoes, watermelon and papaya for lycopene
- Green leafy vegetables and cruciferous vegetables
- Nuts and pumpkin seeds for zinc
- Lean protein for tissue healing
- Curd and probiotics, especially while on antibiotics
Best avoided
- Caffeine and alcohol, which irritate the bladder and worsen urgency — particularly in the evening
- Fluids in the two to three hours before bed
- Excess salt and spicy food while the cavity is healing
- Straining at stool — treat constipation promptly rather than pushing
- Smoking, which is linked to worse urinary symptoms and slower healing
- Cycling and long periods of sitting for six weeks after surgery
Post-operative care, at no extra cost
- Diet and lifestyle consultation with a nutritionist
- Scheduled follow-up calls until you are fully recovered
- Free cab for the follow-up visit
- 24×7 access to your care coordinator for any concern
Enlarged Prostate treatment cost
₹80,000 – ₹2,00,000
The range depends on the technique — conventional TURP, bipolar TURP, HoLEP or ThuLEP laser enucleation — the size of the prostate, your city, the hospital and your room category. Laser procedures cost more but suit larger glands and men on blood thinners. BPH surgery is covered by most health insurance policies; waiting periods apply on newer policies. Our insurance desk verifies eligibility and files the cashless request before admission, at no charge.
Inside the care journey
Enlarged Prostate — your questions answered
No. BPH is a benign enlargement and it does not turn into prostate cancer — they are separate conditions that happen to affect the same gland. A man can have one, both or neither. Because they can coexist and can cause similar urinary symptoms, your urologist checks with a rectal examination and a PSA test, and investigates further if either raises a question. But the diagnosis of BPH itself is not a cancer diagnosis.