Patient Education — BPH Treatment Options
Benign prostatic hyperplasia (BPH) affects millions of men and has many treatment paths. This guide gives you honest, up-to-date information on every major surgical and minimally invasive option — so you can make a truly informed decision alongside Dr. Childs.
At a Glance
The table below summarizes the key differences. Green indicates an advantage; amber indicates acceptable; red indicates a limitation. HoLEP's combination of durability, size-independence, and complete tissue removal makes it uniquely suited as a permanent solution.
| Metric | HoLEP | TURP | RSP | Aquablation | GreenLight | UroLift | Rezūm | PAE |
|---|---|---|---|---|---|---|---|---|
| Tissue Removed | Complete | Partial | Complete | Partial | Vaporized (partial) | None | None (ablated) | None |
| Works for Any Prostate Size | Yes | <80cc ideal | Yes (large glands) | 30–150cc | <100cc ideal | ≤100cc only | ≤80cc | Most sizes |
| Retreatment Rate | <1–2% at 10 yrs | 10–15% at 10 yrs | 5–10% | ~5% at 5 yrs | 10–20% at 5 yrs | 14–20% at 5–8 yrs | ~10% at 5 yrs | 20–30% at 3–5 yrs |
| Hospital Stay | Same day* | 1–2 days | 2–3 days | Overnight typical | Same day–overnight | Outpatient | Outpatient | Outpatient |
| Catheter Duration | Same day removal* | 2–4 days | 7–14 days | 1–3 days | 1–3 days | Hours | 3–7 days | 3–5 days |
| Ejaculatory Function Preserved | Retrograde ejac. common | Usually not | Usually not | Better than TURP | Often retrograde | Yes | Usually yes | Usually yes |
| Erectile Function Risk | Very low | Low–moderate | Low–moderate | Very low | Very low | Minimal | Minimal | Low |
| Blood Loss / Transfusion Risk | Minimal | Moderate | Higher | Moderate (cautery needed) | Low–moderate | Minimal | Minimal | Minimal |
| Safe on Blood Thinners | Yes | Requires stopping | Requires stopping | Usually | Requires stopping | Yes | Usually | Yes |
| Tissue for Pathology | Yes — cancer screening | Yes | Yes | No | No | No | No | No |
| Insurance Coverage | Yes (Medicare & most) | Universal | Most plans | Limited (T-code) | Most plans | Most plans | Most plans | Varies |
| AUA Guidelines Endorsement | Strongly recommended | Recommended | Recommended (large) | Conditional | Conditional | Conditional | Conditional | Conditional |
* Same-day discharge and catheter removal achieved by Dr. Childs for most patients — an advanced approach beyond standard practice.
Gold Standard
HoLEP is widely regarded by the American Urological Association (AUA) and the European Association of Urology (EAU) as the highest-efficacy, lowest-retreatment surgical option for BPH. It is the only size-independent procedure that completely removes the obstructing tissue using laser precision, with no incisions required.
A high-powered holmium laser is passed through the urethra via a resectoscope. The laser precisely enucleates (peels away) the entire adenomatous tissue of the prostate from its surgical capsule — like removing a walnut from its shell. The tissue is then morcellated into fragments inside the bladder and removed. No skin incisions are ever made.
Dr. Childs employs the en bloc technique with early apical release, a cutting-edge refinement that maximizes precision at the apex and optimizes continence outcomes.
Traditional Surgery
TURP has been the most commonly performed BPH surgery for decades and remains widely available. A resectoscope loop shaves away prostate tissue piece by piece. While effective, it removes only partial tissue, carries a meaningful retreatment rate over time, and is less favorable for large prostates or patients on blood thinners.
Robot-Assisted Surgery
RSP uses a robotic surgical system to remove the inner portion of the prostate through small abdominal incisions. It is typically reserved for very large prostates (>100–150cc) where endoscopic options are more technically challenging. When compared directly to HoLEP, RSP has been shown to result in longer hospital stays, higher blood loss, and more complications, while HoLEP achieves equivalent or superior outcomes with no external incisions.
Laser Vaporization
GreenLight laser therapy uses a high-powered green laser to vaporize prostate tissue, opening the urinary channel without cutting or removing the gland. It has been used for many years and is widely available. While it is less invasive than TURP with lower blood loss, it has significant drawbacks compared to HoLEP — particularly around tissue removal completeness, long-term durability, and post-operative irritative voiding symptoms.
Robotic Water Jet
Aquablation uses a high-pressure, robotically-guided water jet to ablate prostate tissue, guided by real-time ultrasound imaging. It has grown in popularity due to its ejaculatory function preservation advantage and shorter learning curve than HoLEP. Symptom improvement is comparable to TURP and HoLEP, but the long-term retreatment durability data still lag behind HoLEP. Aquablation requires a separate electrocautery step for hemostasis, typically an overnight hospital stay, and a catheter for 1–3 days. It currently has limited insurance coverage in the United States.
Minimally Invasive Surgical Therapies
MIST procedures offer outpatient convenience and sexual function preservation, but they do not remove prostate tissue. This means symptoms may return, retreatment rates are meaningfully higher than surgical options, and they are not suitable for all prostate sizes or anatomies. They are best considered for younger men wishing to preserve ejaculatory function, men with smaller prostates, or those who are poor surgical candidates.
The Most Non-Invasive Option Available
No surgery. No general anesthesia. No hospital stay. Just a tiny needle puncture — and a prostate that starts shrinking.
PAE is performed not in an operating room, but by an interventional radiologist — a specialist who treats conditions through tiny catheters guided by imaging. Here is how it works in plain language: a small needle — about the size of an IV line — is inserted into your wrist or groin. Through that tiny opening, a thin flexible tube is guided through your arteries to the blood vessels feeding your prostate. Tiny microspheres (microscopic beads) are then injected, blocking part of the blood supply. Over the next 4–8 weeks, your prostate gradually shrinks as the tissue softens, relieving the obstruction and improving your urinary symptoms.
You go home the same day. Most men return to normal activity within a few days. There are no cuts, no stitches, and no catheter in most cases. Ejaculatory and erectile function are preserved in the vast majority of patients.
PAE is an excellent option for men who want real symptom relief without undergoing surgery — or for those whose health makes surgery a higher risk. Dr. Childs actively discusses PAE with all appropriate patients and works directly with a dedicated PAE clinic through Granger Medical — Summit Urology, ensuring a seamless referral to a specialized team experienced in this procedure.
PAE is available through our affiliated Granger Medical — Summit Urology PAE Clinic. Dr. Childs coordinates care directly with the interventional radiology team, so your evaluation, procedure, and any follow-up care are all managed under one roof — a true prostate center of excellence.
Dr. Childs's Perspective
No two patients are identical, and Dr. Childs believes every man deserves a thorough consultation where all options are laid out honestly — including their limitations. That said, the evidence is clear: for men who are surgical candidates, HoLEP consistently outperforms every alternative on the most important metric: long-term durability.
GreenLight laser vaporization — once widely popular — has fallen behind HoLEP in every meaningful outcome category: retreatment rates, tissue removal completeness, and post-operative irritative symptoms. MIST procedures like UroLift and Rezūm offer convenience, but trade durability for that convenience — men often find themselves back in the office within 5–8 years, sometimes having made their next procedure more complicated.
Dr. Childs performs a high volume of HoLEP procedures and is committed to ensuring every patient can access the full spectrum of BPH care — whether that means performing HoLEP himself, coordinating with our network for Aquablation or Rezūm, or arranging a PAE evaluation through our affiliated clinic. You will never be turned away because we only do one thing.
Next Step
Dr. Childs will take the time to review your specific anatomy, symptoms, and goals — and give you his honest recommendation. Most patients are seen within 1–2 weeks.