34 ways to treat an enlarged prostate.

The AUA 2026 guideline asks clinicians to counsel patients on risk factors for retention and progression — so watchful waiting should be an informed choice, not a default from inaction.

Most often useful for nocturia. If evening fluid restriction fixes your night-time waking, your problem may not have been obstruction at all.

Targets storage symptoms (urgency, frequency) rather than the obstruction itself.

Best evidence is for post-prostatectomy incontinence, not for treating obstruction.

Observational data links metabolic syndrome and hyperinsulinaemia to prostate growth. No trial has shown that reversing it shrinks an already-enlarged prostate. Worth doing for other reasons; do not delay treating obstruction on this basis.

Unregulated for content and purity, and some products interact with anticoagulants. The absence of manufacturer-run RCTs in a category this profitable is itself informative.

Tell your eye surgeon before any cataract operation — tamsulosin causes intraoperative floppy iris syndrome, and the risk persists even years after stopping. This is the most consequential and least-communicated fact about this drug.

Symptom improvement comparable to tamsulosin with minimal cardiovascular effects — but the highest rate of ejaculatory dysfunction in the class. That trade is rarely spelled out at the point of prescribing.

If retrograde ejaculation is your reason for stopping tamsulosin or silodosin, this is the alpha blocker to ask about before abandoning medication altogether.

Cheaper and also lowers blood pressure — occasionally an advantage. Dizziness and falls are the practical limit in older men.

Halves your PSA. Any PSA drawn while you're on it must be doubled for cancer screening interpretation, or a cancer can be missed. A 2024 cohort of 19,938 men found no increase in prostate cancer mortality with prior 5-ARI use.

Blocks both type 1 and type 2 5-alpha reductase. Same PSA-halving caveat as finasteride. Long half-life — effects persist for months after stopping.

Reduces the risk of acute retention and of needing surgery more than either drug alone. Side effects are also additive — this is where most men decide medication isn't worth it.

The only BPH drug that improves erectile function rather than risking it. Cannot be combined with nitrates. Does not shrink the prostate or reduce PSA.

Reversal of prior guidance. Helps preserve ejaculatory function in men who develop retrograde ejaculation on an alpha blocker alone. Watch for low blood pressure when both are started together.

A 2026 phase III trial found the fixed-dose combination produced IPSS improvement roughly twice that of either drug alone at 48 weeks. Recent, single trial — durability beyond a year is not yet established.

For urgency and frequency that persist after obstruction is treated. Raises post-void residual and retention risk — needs a PVR check first. Older anticholinergics carry cognitive burden in men over 70.

Lower retention risk and no cognitive burden compared with anticholinergics — the reason it's increasingly preferred in this age group. Can raise blood pressure.

This is the row that catches misdiagnosis. If a 3-day voiding diary shows your kidneys make most of your urine overnight, your nocturia is not coming from your prostate and no procedure will fix it. Carries a real risk of dangerously low sodium — requires monitoring.

The strongest sexual-function preservation of any procedural option, and the fastest recovery. The weakest durability. One urologist quoted in a patient forum said he has removed more UroLift implants than he has placed — an anecdote, but ask your surgeon their own retreatment rate.

Do not choose this if you are in or near retention. The prostate swells before it shrinks; benefit takes three to six months and the catheter period is longer than marketing usually implies. One prospective series recorded a mean catheter duration above 12 days.

Nothing is left inside you. The device is removed after five to seven days — that removal week is uncomfortable and under-described in patient materials.

Marketed as the least invasive option. Patient reports do not match that framing — catheter for several days and visible bleeding for a week or more are common in forum accounts, against a published recovery estimate of one to two weeks. Too new to know durability.

Included for completeness. Newer minimally invasive options have better durability with comparable invasiveness.

The largest change in the 2026 guideline. Not performed by urologists — it is an interventional radiology procedure, which is a common reason it is never mentioned in a urology consultation. Contested: one randomised comparison against TURP reported a notably high retreatment rate, and PAE's strongest advocates are often high-volume practitioners with a financial interest. Both facts belong in your decision.

Under-offered. For a man with a genuinely small prostate, this achieves much of what TURP does with a markedly lower rate of retrograde ejaculation.

Every trial in this table compares itself to TURP. Bipolar has largely replaced monopolar and removes the risk of TUR syndrome — ask which one your surgeon uses. Expect retrograde ejaculation as the norm, not the exception.

This is surgery, despite being listed as minimally invasive on many comparison sites. Less bleeding than TURP, which makes it the usual choice for men who cannot come off blood thinners.

Image-guided and robot-executed, which removes surgeon-to-surgeon variability — its real advantage. Beware the comparison being made: Aquablation's retreatment figures come from 5-year follow-up and are frequently set against HoLEP's 10-year figures. Those are not the same measurement. Bleeding requiring transfusion is higher than with enucleation.

The most operator-dependent procedure in this table. Outcomes track surgeon volume closely and the learning curve is steep — ask how many your surgeon has performed personally, not how many the hospital has. Temporary stress incontinence in the first weeks is common and under-warned.

Same enucleation principle with a different laser. More widely performed in Europe than in the United States — availability, not evidence, is usually what decides between this and HoLEP.

The most invasive option and the longest recovery. Robotic (RASP) has a substantially easier recovery than open surgery — these are two very different experiences filed under one name on most comparison sites.

Not a failure and not a last resort. For a man who cannot safely undergo anaesthesia, or who does not want a procedure, this manages retention indefinitely with lower infection risk than an indwelling catheter. Almost no comparison site lists it as an option at all.

Carries ongoing infection risk and, over years, bladder stones and other complications. A suprapubic catheter is generally more comfortable and better tolerated long term than a urethral one — many men are never told the option exists.