BPH stands for Benign Prostatic Hyperplasia — the medical term for an enlarged prostate. The prostate gland surrounds the urethra (the tube that carries urine out of the body). As the prostate grows with age, it squeezes the urethra and restricts urine flow, causing the symptoms most men recognize: weak stream, frequent urination especially at night, urgency, difficulty starting, and the feeling of incomplete emptying.
BPH is not cancer and does not increase your risk of prostate cancer. However, left untreated, it can lead to serious complications including urinary retention (inability to urinate at all), bladder damage, and kidney problems.
This is one of the most common questions Dr. Childs addresses in consultation. The short answer is: if your symptoms are affecting your quality of life, you deserve to know your options. Getting up two or more times per night, rushing to the bathroom urgently, or having a weak stream that frustrates you — these are all valid reasons to seek evaluation.
More urgently, if you have ever been unable to urinate and required a catheter (urinary retention), or if you have had recurrent urinary tract infections or blood in your urine, you should be evaluated promptly. Dr. Childs takes a conservative, patient-centered approach — he will never recommend surgery unless the benefits clearly outweigh the risks for your specific situation.
Medications like tamsulosin (Flomax), finasteride, and dutasteride treat the symptoms of BPH but do not address the underlying prostate enlargement. As the prostate continues to grow over time, medications often become less effective — requiring higher doses, additional medications, or eventually becoming insufficient altogether.
This is one of the most compelling reasons to consider HoLEP — it removes the obstructing tissue entirely, eliminating the root cause of obstruction rather than managing its symptoms. Most patients are able to stop all BPH medications after a successful HoLEP procedure.
HoLEP is performed entirely through the urethra — there are no incisions, no cuts, and no scars. A thin instrument called a resectoscope is passed through the natural opening of the urethra. Through this instrument, Dr. Childs uses a high-powered holmium laser to precisely separate and remove the entire inner portion of the prostate (called the adenoma) from its outer shell.
Think of it like removing a walnut from its shell — the obstructing tissue is separated cleanly and completely. The removed tissue is then broken into small pieces inside the bladder using a separate instrument (a morcellator) and suctioned out. The procedure typically takes 60–90 minutes and is performed under general or spinal anesthesia.
Because Dr. Childs uses the advanced en bloc technique with early apical release, the entire obstructing portion of the prostate is removed in a single piece, which improves precision and reduces operative time.
HoLEP is one of the most broadly applicable BPH procedures available — it works for small, medium, and very large prostates, and has no upper size limit. Most men with symptomatic BPH who have failed or wish to avoid medical therapy are potential candidates.
HoLEP is particularly well-suited for men who: have a large prostate (over 80cc), are on blood thinners and cannot stop them, have had prior BPH procedures (TURP, UroLift, GreenLight) that failed, are in urinary retention requiring a catheter, or simply want the most durable long-term result available.
The best way to determine candidacy is a consultation with Dr. Childs, which includes a thorough review of your symptoms, a physical examination, and a discussion of your goals and preferences.
TURP (Transurethral Resection of the Prostate) has been the standard BPH surgery for decades and remains widely performed. However, HoLEP is now considered the superior option by the American Urological Association for most patients, for several important reasons:
TURP shaves away prostate tissue in pieces, leaving some tissue behind. HoLEP removes the entire obstructing portion of the prostate cleanly. This difference in completeness is why HoLEP's retreatment rate (less than 1–2% at 10 years) is dramatically lower than TURP's (10–15% at 10 years). TURP also requires stopping blood thinners, carries a higher blood loss risk, and is less effective for very large prostates. Dr. Childs performs TURP for patients in whom it is the most appropriate choice, but HoLEP is his preferred recommendation for most surgical candidates.
Yes — in most cases. HoLEP is one of the most effective salvage procedures for patients who have had a prior BPH procedure that failed or produced recurrent symptoms. Dr. Childs regularly treats patients in this situation.
For patients who have had UroLift specifically, the permanent implants must first be removed before HoLEP can be performed. Dr. Childs offers UroLift removal as a service for this reason. If you have had a prior procedure that is no longer working, please schedule a consultation — you are not out of options.
Yes — and this is one of the most immediately life-changing benefits of HoLEP. The vast majority of patients discontinue all BPH medications on the day of surgery or within days. Flomax (tamsulosin), finasteride, dutasteride, and other BPH medications are stopped immediately — not tapered, not gradually reduced. Stopped.
The reason is straightforward: these medications exist to manage the symptoms caused by the obstructing prostate tissue. HoLEP removes that tissue entirely. Once the mechanical obstruction is gone, there is nothing left for these medications to treat. Most patients never need to start them again.
This has real implications beyond convenience. Flomax causes dizziness, low blood pressure, and retrograde ejaculation in many men. Finasteride affects libido and sexual function and requires indefinite use — the prostate regrows if you stop it. Eliminating these medications permanently is a quality-of-life gain that patients often describe as one of the most welcome changes after surgery.
Some BPH symptoms are inconvenient. Others are warning signs of damage that can become permanent. Here's how to know the difference:
Call immediately if you experience: Complete inability to urinate (acute urinary retention — a urological emergency), blood in the urine, or signs of kidney problems such as rising creatinine on blood work. Recurrent urinary tract infections — two or more per year — also require prompt evaluation, as they suggest your bladder is not emptying properly.
Schedule soon if you notice: Waking up 2 or more times per night to urinate, a noticeably weak or slow stream, straining to start urination, a stream that stops and starts, or a persistent feeling that your bladder never fully empties. These symptoms indicate progressive obstruction.
Don't wait if: Your BPH medications are no longer controlling your symptoms, your symptoms are worsening despite medication, or your quality of life — sleep, work, travel, activity — is significantly affected.
Many men tolerate these symptoms for years assuming this is just part of aging. It isn't. Left untreated, progressive obstruction can cause irreversible bladder damage and kidney problems. Early evaluation leads to better options and better outcomes.
Your initial consultation with Dr. Childs is a genuine, unhurried conversation about your symptoms, your history, and your goals. He will review any prior imaging or lab work, perform a physical examination, and discuss all relevant treatment options — including which ones he would and would not recommend for your specific situation.
Please bring: a list of your current medications (especially blood thinners), any prior urology records or imaging, a summary of your symptom history, and a list of questions. Bringing your spouse or a family member is encouraged — Dr. Childs welcomes their involvement in the conversation.
In most cases, no. This is one of HoLEP's most significant advantages over TURP and other surgical options. The holmium laser provides excellent hemostasis (bleeding control) during tissue removal, which means many patients on blood thinners such as warfarin, apixaban (Eliquis), rivaroxaban (Xarelto), or aspirin can safely undergo HoLEP without stopping their anticoagulation.
Dr. Childs will review your specific medications and situation at consultation and provide individualized guidance. Patients on blood thinners who have been turned away from other BPH procedures are often excellent candidates for HoLEP.
Dr. Childs's practice is designed to move efficiently. Most patients are seen for an initial consultation within 1–2 weeks of calling. Following consultation, pre-operative clearance is coordinated promptly, and surgical scheduling is typically possible within a few weeks thereafter.
If you are in urinary retention and catheter-dependent, Dr. Childs prioritizes your case and will work to expedite your path to surgery as quickly as safely possible.
You will arrive at the surgical facility in the morning, typically fasting from midnight the night before. You will be checked in, meet the anesthesia team, and confirm your surgical plan with Dr. Childs before proceeding to the operating room.
The procedure itself takes approximately 60–90 minutes. After surgery you will spend time in the recovery area as the anesthesia wears off. Dr. Childs's goal is to remove the catheter before you leave — most patients go home the same day with no catheter in place. This is one of the most distinctive aspects of Dr. Childs's practice and is not standard at most centers.
You will need someone to drive you home. Plan to take it easy for the rest of that day.
Yes, in most cases. Same-day discharge with same-day catheter removal is Dr. Childs's standard approach — and it sets his practice apart from virtually every other HoLEP program in the region. Most centers keep patients overnight with a catheter for 1–2 days. Dr. Childs has refined his technique and post-operative protocols to make same-day recovery safe and routine for the majority of patients.
There are occasional circumstances — a particularly large prostate, an unexpected intraoperative finding, or a patient with certain medical complexities — where an overnight stay or short-term catheter may be recommended. Dr. Childs will discuss this with you beforehand and will always prioritize safety over protocol.
Most patients are surprised by how manageable the recovery is. Because HoLEP involves no external incisions and minimal blood loss, the healing process is primarily internal — and the body recovers quickly.
In the first 1–2 weeks, you may experience some urinary frequency, urgency, and mild burning — this is normal as the urethra heals. Blood-tinged urine is also common and typically resolves within a few days. Most patients are moving around normally within 24–48 hours.
Most men return to light activity within 1–2 weeks and full normal activity including exercise within 3–4 weeks. Heavy lifting and strenuous exercise are typically restricted for 4 weeks. Dr. Childs's team will provide clear, specific post-operative instructions before you leave the facility.
Temporary urinary urgency and mild leakage are common in the first few weeks after HoLEP — the bladder and urethra need time to adjust after years of working against an obstruction. Most men find this resolves progressively over 4–8 weeks.
Long-term stress incontinence (leakage with coughing, laughing, or lifting) is rare with HoLEP when performed by an experienced surgeon — large published series show rates of approximately 1–2% at one year. Dr. Childs's use of the early apical release technique is specifically designed to optimize preservation of the urinary sphincter and minimize this risk.
Pelvic floor exercises (Kegel exercises) are recommended in the weeks before and after surgery and significantly reduce the duration of any temporary urinary symptoms.
Most patients notice a dramatic improvement in urinary flow immediately after surgery — often the very first time they urinate post-operatively. The stream is typically much stronger than anything they have experienced in years.
Full urinary function optimization typically occurs over the first 6–12 weeks as the bladder recovers from years of working against an obstruction. Nocturia (nighttime urination) often improves within a few weeks. The majority of patients report their urinary symptoms are essentially resolved by the 3-month follow-up visit.
HoLEP produces the most durable results of any BPH surgical option available. Because the entire obstructing portion of the prostate is removed — not just reduced — there is minimal tissue left to regrow. The retreatment rate for HoLEP is less than 1–2% at 10 years, which is dramatically better than TURP (10–15%), UroLift (14–20%), or ablative procedures like GreenLight or Rezūm.
For the vast majority of men, HoLEP is a permanent solution. You should not expect to need another prostate procedure for the rest of your life.
Because HoLEP removes actual prostate tissue — unlike ablative or mechanical procedures — that tissue is sent to a pathologist for examination. This means any incidental prostate cancer present in the removed tissue will be detected. This is a genuinely important benefit that MIST procedures, GreenLight, and Aquablation simply cannot offer.
HoLEP does not treat prostate cancer and is not a substitute for prostate cancer screening. However, the pathology specimen provides an additional layer of information that can be valuable for your ongoing health monitoring.
Erectile function is preserved in the vast majority of HoLEP patients. The risk of new erectile dysfunction from HoLEP is very low — studies consistently show rates below 1–3%. HoLEP does not involve the nerves responsible for erection, which run outside the prostate capsule well away from the operative field.
In fact, some patients report improved sexual function after HoLEP, likely because the relief of obstruction and elimination of BPH medications (many of which affect sexual function) has a net positive effect.
This is one of the most important questions to discuss honestly. HoLEP, like TURP, typically causes retrograde ejaculation — during orgasm, semen travels backward into the bladder rather than forward out of the body. This is sometimes called a "dry orgasm." It is not painful and does not affect the sensation of orgasm, but it does mean semen is not expelled normally.
Retrograde ejaculation is a consequence of removing the inner prostate tissue, which includes a muscle that normally closes during ejaculation. This affects fertility — if fathering children is a priority, this should be discussed with Dr. Childs before proceeding with any surgical BPH treatment. For most men beyond their reproductive years, retrograde ejaculation is a fully acceptable trade-off for dramatic, lasting relief of urinary symptoms.
If preserving ejaculatory function is a high priority, Dr. Childs will discuss alternatives such as UroLift, Rezūm, Aquablation, or PAE — all of which generally preserve ejaculation at the cost of reduced long-term durability.
Yes — HoLEP is covered by Medicare and most major insurance plans as a standard surgical treatment for BPH. Dr. Childs's office accepts Medicare as well as a broad range of commercial insurance plans including Aetna, Cigna, Blue Cross Blue Shield, United Healthcare, and Humana, among others.
Prior to scheduling surgery, Dr. Childs's team will verify your specific benefits and provide an estimate of any out-of-pocket costs. Please call the office or use the contact form to ask about your specific insurance plan.
In most cases, no referral is required to schedule a consultation with Dr. Childs. Many patients contact the office directly after researching their options. However, some insurance plans do require a referral for specialist visits — please check your specific plan if you are unsure.
If your plan requires a referral and your primary care physician is not familiar with HoLEP or Dr. Childs's practice, the office team can help facilitate that process.
This is a fair question and one Dr. Childs welcomes directly. The honest answer comes down to three things: volume, focus, and experience.
Volume: Dr. Childs performs HoLEP as his primary surgical procedure — not occasionally alongside a general urology caseload. Surgical volume is the single most consistent predictor of outcomes in the medical literature. The more a surgeon performs a specific procedure, the better the results become.
Focus: In large academic or hospital-employed urology departments, surgeons divide their time across research, teaching, administrative duties, and a wide variety of procedures. Dr. Childs has built his practice specifically around BPH and HoLEP. His protocols, his technique, and his entire practice infrastructure are optimized for this.
Experience: Dr. Childs employs advanced techniques — including same-day catheter removal and the en bloc early apical release approach — that are not routinely offered elsewhere in Utah. These reflect a level of mastery developed through high-volume, dedicated practice.
For a full discussion of this topic, see our Why Choose a Specialist page.
You will see Dr. Childs at every appointment — consultation, pre-operative visit, the procedure itself, and all post-operative follow-ups. Dr. Childs's practice is not a teaching program. There are no residents performing procedures on his patients and no rotating attendings. You get the same surgeon, the same expertise, and the same continuity at every visit.
This is one of the most important differences between private specialist practice and a large hospital urology department, and one that patients consistently find meaningful.
You can schedule by calling the office directly at (801) 432-3022 or by submitting the consultation request form on our website. Most patients are seen within 1–2 weeks of their initial inquiry.
If you are catheter-dependent or in urinary retention, please indicate that when you call — Dr. Childs prioritizes these patients and will work to see you as quickly as possible.
Absolutely — and Dr. Childs encourages it. A significant number of his patients come specifically for a second opinion after being told by another provider to pursue surgery (or not to). Getting a second opinion before a surgical procedure is entirely reasonable and should be welcomed by any surgeon worth seeing.
Dr. Childs will give you a thorough, honest evaluation and tell you what he genuinely recommends — including if he thinks you are not yet a candidate for surgery, or if a less invasive option would serve you better. His goal is the right answer for you, not a filled operating room schedule.