When medicine for an enlarged prostate is not doing enough, or you would rather not take it, three procedures come up most often. They work in very different ways. Here is how they line up.
| UroLift | PAE | HoLEP / ThuLEP | |
|---|---|---|---|
| How it works | Small implants hold the enlarged tissue aside, like curtain tiebacks. Nothing is cut, heated or removed. | Tiny particles cut down the prostate's blood supply, and the gland shrinks, on average by about 25 to 30 percent. | A laser removes the blocking tissue and leaves the outer shell of the prostate. |
| Who performs it | Our urologists, through the urethra | Our interventional radiologists, through the radial artery at the wrist | Our urologists, through the urethra |
| Sedation and going home | Outpatient for most men, with no overnight stay | Light sedation or none for most men | General anesthesia |
| Catheter | Often none; if used, typically overnight | None | Typically about a week |
| Relief | The channel opens right away | Within about a week, improving for about six months | Blocking tissue is removed, so few men need another procedure for it |
| Common trade-offs | About two weeks of burning and frequency; in the main study about 1 in 7 men had another procedure within five years | About a week of burning and frequency; bruising or a hematoma at the wrist; rarely, particles reach a nearby organ; symptoms can return over years | Most men have dry orgasm afterward; some have temporary leakage that improves over weeks to months |
| Usually suits | Prostates under about 50 grams, when quick relief matters | Larger prostates, when the least invasive route matters | Men who cannot urinate and need a catheter, or when PAE did not help enough |
Sexual function
UroLift and PAE are known for preserving ejaculation and sexual function in most men. With HoLEP and ThuLEP, semen usually flows back into the bladder instead of out (dry orgasm). That is not harmful, but it matters to some men, so raise it at your visit.
Why one practice offering all three helps
Advanced Urology's urologists perform UroLift, HoLEP and ThuLEP, and its interventional radiologists perform PAE. Because all three are available in one practice, the recommendation can follow your prostate and your priorities rather than whichever procedure a single clinic happens to offer.
Before you decide
Before choosing, we size your prostate and measure what is left in the bladder after you urinate. All procedures, and the anesthesia used for them, have risks, and our urologists explain which of them matter in your case before anything is scheduled. Signs of an enlarged prostate include nighttime waking to pass urine, a sluggish flow, a sense of incomplete emptying, and many trips during the day. Being unable to urinate at all needs emergency care.
Read more about enlarged prostate care in Sandy Springs or Advanced Urology's BPH page.