Prostate Enlargement (BPH)
Specialist, London
Expert assessment and the full range of surgical treatments for benign prostatic hyperplasia — from minimally invasive outpatient procedures to advanced laser surgery.
Book a Consultation Send an EnquiryImportant: Prostate enlargement (BPH) is not cancer and does not increase your risk of prostate cancer. But left untreated, it can cause progressively worsening urinary symptoms, recurrent infections, bladder damage, and — in some cases — complete inability to pass urine. Effective, well-tolerated treatments are available and most patients are back to normal within days to weeks.
Start here — symptoms and diagnosis
This page focuses on surgical treatments for BPH. If you are still at the stage of understanding your symptoms, investigating what is causing them, or considering whether medication might be right for you first, please visit the relevant pages below.
What happens when the prostate enlarges
The prostate gland surrounds the urethra — the tube that carries urine from the bladder out of the body. As the prostate grows, it compresses the urethra from all sides, restricting flow. The bladder works harder to overcome the obstruction, eventually leading to urgency, frequency, incomplete emptying, and — if untreated — retention or bladder damage.
When is surgery considered?
Surgery is not the first step for most men. The pathway from symptoms to surgery follows a logical progression, and many men are well managed with lifestyle changes and medication for years. Surgery is recommended when medication has not provided adequate relief, or when there are complications of obstruction.
Surgery is also recommended without delay when BPH causes urinary retention, recurrent infections, bladder stones, or progressive kidney damage due to obstruction.
Choosing the right procedure
No single procedure is right for every man. The best choice depends on prostate size, anatomy, symptom type, co-morbidities, and — critically — what matters most to the individual patient. Mr Sri offers five procedures, across two broad categories.
Ejaculatory-preserving procedures Sexual function preserved
Sterile water vapour (steam) is delivered in 9-second bursts directly into the enlarged prostate tissue through the urethra. The thermal energy causes cell death; over the following weeks, the body absorbs the treated tissue and the prostate shrinks, opening the urethra.
Performed under local anaesthetic or light sedation. No incisions. Most patients go home the same day with a short-term catheter for a few days during healing.
A robotically guided high-pressure waterjet resects prostate tissue with precision, directed by real-time ultrasound imaging. The robotic delivery removes the surgeon's hand from the cutting process, offering highly consistent tissue removal regardless of prostate size or anatomy.
Performed under general anaesthetic. Particularly advantageous for larger or anatomically complex prostates. Strong efficacy data with a favourable sexual side-effect profile.
Cavitatory / tissue-removing procedures Higher retrograde ejaculation risk
A high-powered green laser is passed through the urethra and vaporises prostate tissue on contact. The laser energy is selectively absorbed by haemoglobin in prostate blood vessels, providing precise tissue ablation with minimal bleeding.
Particularly useful in men on anticoagulants who cannot safely stop medication. Generally performed as a day case under general anaesthetic.
The gold-standard surgical treatment for BPH for decades. A heated wire loop is passed through the urethra and removes prostate tissue in chips, creating a wider channel for urine to flow. Highly effective with well-established long-term data.
Typically requires an overnight stay. Catheter for 24–72 hours. The benchmark against which all newer treatments are compared in clinical trials.
The most complete endoscopic treatment for BPH. A holmium laser is used to enucleate (remove in entirety) the inner lobes of the prostate — akin to removing the core of an apple — leaving only the outer capsule. The removed tissue is morcellated and evacuated. Unlike TURP or laser ablation, the entire obstructing tissue is removed rather than merely vaporised or chipped.
HoLEP has the highest symptom improvement rates of all BPH procedures (90–95%), the lowest re-treatment rate (1–5% at 5 years), and works for prostates of any size — making it particularly suited to larger glands where other procedures may be less effective. It requires general anaesthetic and surgical expertise.
Comparing the procedures at a glance
The table below summarises the key factors that differ between procedures. Mr Sri will guide you through what is most relevant to your personal circumstances at your consultation.
| Procedure | Anaesthetic | Catheter | Hospital stay | Ejaculation preserved | Prostate size | 5-yr re-treatment |
|---|---|---|---|---|---|---|
| Rezum | Local / sedation | 3–5 days | Day case | ✓ Yes (<3%) | 30–80ml | ~4.4% |
| Aquablation | General | 24–48 hr | Overnight | ~ Low risk (5–20%) | 60–150ml | ~5% |
| Greenlight PVP | General | 24 hr | Day case | ~ 35–65% affected | Best <80ml | ~10% |
| TURP | General / spinal | 24–72 hr | 1–2 nights | ✗ 50–80% affected | Best <80ml | 10–15% |
| HoLEP | General | 24 hr | Overnight | ✗ 75–85% affected | Best for >80ml | 1–5% |
Retrograde ejaculation is harmless and not the same as erectile dysfunction. Erection function is largely preserved across all BPH procedures.
NHS decision support tool
This NHS England decision aid walks you through all the treatment options for an enlarged prostate — from lifestyle measures and medication through to every surgical option — with evidence-based data on how well each works, how many men have side effects, and prompts to help you think about what matters most to you personally. It is an excellent resource to read before or after your consultation with Mr Sri, and can be brought to your appointment to help guide the conversation.
Download the decision aid →Recovery — what to expect
Recovery varies significantly between procedures. The general principles below apply across all BPH surgery.
Frequently asked questions
Clinic locations
Mr Sri sees patients at three private hospital locations in and around London.
Cheam, Surrey SM3 9DW
Tel: 020 8337 6691
Wimbledon SW19 5NX
Tel: 020 8971 8000
Marylebone W1G 7AF
Tel: 020 379 77248
Ready to explore your options?
Same-week appointments available. No GP referral required.
Self-pay and all major insurers accepted.