BPH / Benign Prostate Enlargement (ThuLEP, Rezūm, TUMT)
An enlarged prostate is not in itself a reason for treatment. What matters is how much the symptoms restrict daily life and whether the bladder is being harmed — the method is chosen after that.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 30–90 minutes depending on method
- Anesthesia
- General or spinal; usually sedation for Rezūm
- Hospital stay
- Day case – 2 nights
- Stay in Türkiye
- 5–8 days
- Catheter duration
- 1–7 days depending on method
- Return to work
- 1–3 weeks
- Flight clearance
- After catheter removal and review
About the condition
Benign prostatic hyperplasia (BPH) is enlargement of the prostate with age, compressing the urinary channel. A weak stream, hesitancy, frequency, waking at night and a feeling of incomplete emptying are the typical symptoms.
BPH IS NOT CANCER and does not turn into cancer. Because both can occur in the same organ, however, cancer is assessed separately with PSA and examination in any man presenting with urinary symptoms.
AN IMPORTANT DISTINCTION: the size of the prostate alone is not a reason for treatment. Some men have a large prostate and no symptoms; others have a small prostate and considerable difficulty. The decision rests on your symptoms and the state of your bladder, not on the volume measured on ultrasound.
THERE ARE, HOWEVER, SITUATIONS IN WHICH WAITING IS NOT SAFE: repeated inability to pass urine, bladder stones, recurrent urinary infections, recurrent bleeding from the prostate, and deterioration in kidney function. These are not matters of comfort but signs of damage already occurring.
The prostate is not always the only cause. Overactive bladder, nerve involvement from diabetes, certain medications and sleep apnoea can produce a similar picture. Assessment therefore comes before turning straight to the prostate.
Who is it suitable for?
May be suitable
- Men who gain insufficient benefit from medication or cannot tolerate its side effects
- Men whose symptoms markedly restrict daily life and sleep
- Men catheterised because of retention
- Men who have developed bladder stones
- Men with recurrent urinary tract infections
- Men with recurrent bleeding from the prostate
- Men with impaired kidney function caused by the obstruction
May not be suitable
- Men with mild symptoms who are not troubled by them — unnecessary intervention is avoided
- Men with untreated urinary infection: the infection is treated first
- Men whose symptoms arise from the bladder rather than the prostate — prostate surgery will not deliver the expected benefit
- Men still planning to father children, in whom tissue-removing methods may not be the first choice
- Men at high anaesthetic risk, in whom less invasive options come to the fore
Technology used
- Uroflowmetry and measurement of post-void residual urine
- Ultrasound determination of prostate volume
- PSA and digital rectal examination — to assess cancer separately
- Thulium laser enucleation (ThuLEP) — the enucleation technique used first in our clinic
- Holmium laser enucleation (HoLEP) — a similar technique working on the same principle
- Transurethral microwave thermotherapy (TUMT) — tissue shrinkage by heat
- Water vapour therapy (Rezūm)
- Conventional endoscopic resection (TURP)
- Urodynamics in selected patients — to distinguish bladder from prostate as the source of symptoms
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Initial assessment
Imaging showing prostate volume, uroflowmetry and residual urine measurement, your PSA, your complete medication list (particularly anticoagulants) and your other medical conditions are reviewed.
- Day 1
Arrival and examination
Examination, repeat tests if needed, urinalysis and culture, anaesthetic assessment. If the culture grows an organism, the procedure is postponed.
- Day 2
Procedure
Performed according to the chosen method. Enucleation removes the inner portion whole; Rezūm delivers steam; TURP shaves tissue progressively.
- Day 3
Discharge
Most patients go home the following day. The duration of catheterisation depends on the method and is explained in advance.
- Days 4–7
Catheter removal and review
The catheter is removed here, so that difficulty passing urine is dealt with close to the hospital. After Rezūm you are reminded that the real improvement arrives over weeks.
Method comparison
| Criterion | ThuLEP (thulium enucleation) | Rezūm (vapour) | TUMT (microwave) | TURP |
|---|---|---|---|---|
| What happens to the tissue | Removed completely | Left in place, absorbed over time | Left in place, shrinks with heat | Partially shaved away |
| Prostate size limit | No practical ceiling | Small to moderate | Small to moderate | Small to moderate |
| When the benefit starts | Immediately | Over weeks | Over weeks | Immediately |
| Ejaculation preserved | Less likely | More often preserved | More often preserved | Less likely |
| Temporary leakage | Can occur | Not expected | Not expected | Less frequent |
| Bleeding control | Good — favoured on anticoagulants | Limited data; unsuitable with heavy bleeding | Bleeding not expected; can be done as an outpatient | Moderate |
| Chance of a further procedure | Lower | Higher | Higher | Intermediate |
| Hospital stay | 1 night | Day case | Day case | 1–2 nights |
| Tissue available for pathology | Yes, the removed tissue is examined | No tissue is removed | No tissue is removed | Yes, the removed tissue is examined |
The right question is not which method is more advanced but which trade-off suits you. If preserving ejaculation and sexual function is your priority, say so plainly; if definitive resolution of your urinary symptoms is the priority, say that. They point to different methods. Note too that where tissue is removed it is examined, which can reveal an unsuspected cancer.
Risks
- RETROGRADE EJACULATION: common after tissue-removing methods, with semen passing into the bladder instead of outwards. It is harmless and affects neither erections nor desire, but it impairs fertility and some men find it unwelcome. If you wish to father children, say so before surgery
- TEMPORARY URINARY LEAKAGE: particularly after enucleation, because continence then depends on a single muscle. It settles within weeks in most men; pelvic floor exercises shorten the process
- Stinging and blood in the urine — expected in the first days
- Urinary tract infection
- Inability to pass urine after catheter removal, requiring temporary recatheterisation
- Narrowing of the urethra or bladder neck developing over time
- The need for a further procedure in later years — more likely with methods that do not remove the tissue completely
- With Rezūm, a temporary worsening of symptoms in the first weeks and a delayed onset of benefit
Alternatives
- Lifestyle measures — reducing evening fluids, limiting caffeine and alcohol, treating constipation. Measurable benefit in mild symptoms
- Alpha blockers — relax the bladder neck and improve flow relatively quickly; they can cause dizziness, a drop in blood pressure on standing, and changes in ejaculation
- 5-alpha reductase inhibitors — shrink the prostate over months. IMPORTANT: they roughly halve the PSA value; if you take one, always tell whoever interprets your PSA
- Combination of the two, in selected patients
- Rezūm (water vapour) — less invasive and more likely to preserve ejaculation; the benefit begins later
- Prostatic urethral lift (UroLift) — no tissue removed, suitable for selected anatomy
- TURP — the established endoscopic method
- ThuLEP (thulium laser enucleation) — complete removal of the obstructing tissue; prominent for large glands. Where enucleation is indicated, this is the first choice in our clinic
- HoLEP (holmium laser enucleation) — a similar technique working on the same principle
- TUMT (transurethral microwave thermotherapy) — tissue shrinkage by heat; less invasive, with a delayed benefit
- Prostatic artery embolisation — an interventional radiology option in selected patients
Recovery
First 48 hours
Blood in the urine and stinging are expected. Drink plenty. Seek care immediately for fever or inability to pass urine.
First days after catheter removal
Frequency and urgency are usual. A small number of men need the catheter replaced temporarily, which is why a flight is not planned for the day after removal.
Weeks 1–4
Temporary leakage can follow enucleation; pelvic floor exercises are done consistently. Avoid lifting and straining, and prevent constipation.
Weeks 2–6 after Rezūm
The real improvement becomes apparent in this period. A temporary worsening in the first weeks is usual and does not mean the procedure has failed.
Months 1–3
Marked improvement in flow and in waking at night is expected. The result is assessed with repeat uroflowmetry and residual urine measurement.
Long term
If symptoms return, the cause is investigated; not every recurrence comes from the prostate. Bladder-related symptoms are assessed separately.
Frequently asked questions
My prostate is large — do I need surgery?
Size alone is not a reason for treatment. Some men have a large prostate and no symptoms at all. The decision rests on how much your symptoms restrict daily life and whether your bladder and kidneys are being harmed.
When is it not safe to wait?
If you have been catheterised because you could not pass urine, if bladder stones have formed, if you have recurrent urinary infections, if the prostate bleeds repeatedly, or if kidney function has started to deteriorate. These are not matters of comfort but signs of damage.
Does BPH turn into cancer?
No. Benign enlargement is not cancer and does not become cancer. The two can coexist in the same organ, however, so cancer is assessed separately with PSA and examination in any man with urinary symptoms.
Should medication be tried first?
In most men, yes. Alpha blockers improve flow relatively quickly; drugs that shrink the prostate take months to work. Interventional options come into play when medication gives insufficient benefit or its side effects cannot be tolerated.
I take a prostate-shrinking drug — does it affect my PSA?
Yes, and this is frequently overlooked. 5-alpha reductase inhibitors roughly halve the PSA value. If you do not mention that you take one, a PSA result that actually warrants attention may be read as normal. Tell your doctor at every PSA test.
Will my sexual function be affected?
The most common change is that semen passes backwards into the bladder instead of outwards (retrograde ejaculation). It is harmless and affects neither erections nor desire, but it does impair fertility. Rezūm is reported to preserve ejaculation more often.
I still want children — what should I do?
Say so at the start of the assessment. Tissue-removing methods may not be the first choice in that situation and the plan changes. Mentioning it afterwards leaves you with a result that cannot be undone.
Will I leak urine after the operation?
Temporary leakage can occur, particularly after enucleation, because continence then depends on a single muscle. It settles within weeks in most men. Learning pelvic floor exercises BEFORE surgery makes this easier.
Which method lasts longer?
Enucleation, which removes the tissue completely, carries a lower chance of needing a further procedure in later years. Rezūm is less invasive but that chance is higher. If you are travelling from abroad, weigh the possibility of a second journey in this decision.
I take blood thinners — which method suits me?
Enucleation is favoured in these patients because bleeding is well controlled. Medication is nonetheless managed individually; do not stop anything on your own, and send your full list in advance.
How long does the catheter stay in?
It depends on the method and on the prostate, but it is usually a few days. It is removed here so that any difficulty passing urine is managed close to the hospital. Do not plan your flight for the day after removal.
What should I send before coming?
Ultrasound or other imaging showing prostate volume, uroflowmetry and post-void residual if available, a current PSA, a urinalysis, a complete list of your medication including anticoagulants, and your other medical conditions. With these, the right method can be assessed before you travel.
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Treatments in this category
Rezūm: Water Vapour Therapy for the Prostate
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Learn moreThuLEP (Thulium Laser Enucleation of the Prostate)
An endoscopic method in which the obstructing tissue of an enlarged prostate is enucleated whole with a thulium laser.
Learn moreHoLEP (Holmium Laser Enucleation of the Prostate)
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Learn moreTUMT (Transurethral Microwave Thermotherapy)
An option for benign prostate enlargement in which microwave energy delivered through the urinary passage heats and shrinks prostate tissue, without an operating theatre or general anaesthesia.
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