All Prostate Surgeries: TURP, Water Vapor Therapy Of Prostate, Open Prostatectomy, and Radical Prostatectomy

Prostate surgery is not one single operation. Different procedures are used for different prostate problems. Some surgeries are performed to improve urine flow in men with benign prostate enlargement. Others, such as radical prostatectomy, are performed to remove the prostate in selected patients with prostate cancer.

The right surgery depends on the reason for treatment, the size of the prostate, the severity of urinary obstruction, previous response to medication, general health, anesthesia risk, and the patient’s priorities regarding recovery, urinary control, sexual function, and fertility.

When prostate surgery may be considered

A prostate procedure may be considered when symptoms remain troublesome, medicines are unsuitable or poorly tolerated, or a suitable patient prefers an alternative to ongoing medication. Not every patient must first try every medicine or wait for complications. The decision should reflect the degree of obstruction, bladder function, anatomy, overall health and the outcomes that matter to the patient.

It may also be considered when the patient cannot urinate, has severe obstruction, has blood in urine, has bladder stones, has recurrent urinary tract infections, or has kidney injury related to urinary obstruction.

For prostate cancer, surgery may be considered when the disease is suitable for surgical removal, especially when cancer is limited to the prostate.

1) Rezūm water-vapour therapy

Rezūm is a minimally invasive procedure delivered through the urethra without a skin incision. Controlled water-vapour energy causes thermal injury to selected obstructing prostate tissue. The treated tissue gradually reduces during healing; it is not immediately resected or removed during the procedure, and no permanent prostate implant is left behind.

The current US FDA-cleared indication includes men aged 50 or older with prostate volumes of 30–150 mL (cc), following the 2025 indication expansion. Prostate shape, bladder function, retention, symptoms and the locally applicable device instructions still determine suitability. The US clearance does not by itself confirm the local registration or appropriateness of treatment for an individual patient.

Preservation of erectile and ejaculatory function is an important potential advantage for suitable men, but sexual or urinary side effects are not impossible. Improvement is gradual, and a temporary catheter is commonly required. Local anaesthesia, sedation or another anaesthetic approach may be chosen; the setting and admission plan depend on the patient.

Rezūm can be discussed before starting medicines or when a suitable patient wishes to avoid continued medication. It is not automatically preferable for every prostate or every degree of obstruction. Read the detailed Rezūm guide for catheter care, follow-up, special health circumstances and the possibility of further treatment. FDA clearance K250584.

2)TURP / prostate shaving / transurethral resection

TURP is described as one of the older and effective operations for BPH. A resectoscope is passed through the urethra to remove the prostate tissue that blocks urine flow.

The website also uses the term prostate shaving. In this technique, the surgeon removes or shaves part of the enlarged prostate through the urinary passage. It usually requires anesthesia and catheter placement after surgery.

TURP can provide substantial relief of obstruction in an appropriate patient. Prostate size and anatomy, symptom burden, complications and preferences help determine whether it is suitable. Retrograde ejaculation or other ejaculatory changes are important considerations, alongside bleeding, infection, temporary urinary symptoms and the individual risk of other complications.

3)TUIP

TUIP is described as a transurethral incision procedure. Unlike TURP, tissue is not removed. Small cuts are made in the prostate to reduce pressure on the urethra.

The website content suggests this may be used in some patients with smaller prostates and may have a lower risk of retrograde ejaculation than TURP, although it may need repetition.

4) Laser prostate surgery

Laser treatment includes several different operations. Vaporisation removes tissue using laser energy, while enucleation techniques such as HoLEP separate and remove the obstructing enlarged tissue. HoLEP can be particularly useful in large prostates; it should not be described as ineffective simply because a gland is very large.

Laser surgery may offer substantial and durable relief, but its recovery and ejaculatory effects differ from those of Rezūm. The exact technique, surgeon’s experience, anatomy and patient priorities matter. Discuss the procedure by its specific name rather than treating all laser operations as interchangeable.

Aquablation

Aquablation uses an image-guided water jet to remove obstructing prostate tissue. It is different from Rezūm’s thermal water-vapour treatment. The expected relief, anaesthesia, bleeding considerations, ejaculation outcomes and recovery should be discussed for the individual patient; its side-effect profile should not be assumed to be identical to standard TURP or HoLEP.

5)Open prostatectomy for benign enlargement

Open prostate surgery may be recommended when the prostate is very large, when disease complications are severe, or when the bladder needs repair. The website describes it as a more invasive approach with a longer recovery period.

For very large benign prostates, the central enlarged part of the prostate may be removed while the outer peripheral part and capsule remain. The operation may require bladder opening, catheter placement, and more postoperative care.

6)Radical prostatectomy for prostate cancer

Radical prostatectomy is performed to remove the whole prostate gland for prostate cancer. The website explains that the treatment choice for prostate cancer depends greatly on the stage of the tumor.

Radical prostatectomy may be performed alone or combined with radiation or hormone therapy when the treating physician recommends it. Before surgery, bone scan, CT scan, PET scan in some cases, and blood tests may be needed.

How to compare Rezūm with tissue-removing treatments

The methods are different, but comparing them remains useful. Rezūm may appeal to a suitable patient who prioritises a less invasive procedure and preservation of sexual function. TURP, HoLEP or another tissue-removing operation may be more appropriate when a greater or more immediate reduction of obstruction is needed. No single approach is best for every patient.

• How obstruction is treated: Rezūm treats tissue that gradually reduces; TURP, HoLEP and Aquablation remove tissue during treatment. UroLift instead uses small implants to hold tissue aside.
• Sexual priorities: discuss erections, ejaculation and fertility separately. Risks vary between techniques, and no procedure should be presented as guaranteeing zero sexual effects.
• Recovery: compare anaesthesia, admission, catheter care, temporary urinary symptoms and return to activity, not just the length of the procedure.
• Durability: consider symptom relief and the possibility of further medicine or another procedure. The pivotal Rezūm study documented benefits through five years in men with 30–80 mL prostates; this does not predict the same course for every patient or larger gland.
• Bladder health: removing prostatic obstruction does not automatically correct every cause of urgency or leakage.

Bring your prostate-volume report and medication list to compare options with Dr. Amin. Read the enlarged prostate and Rezūm questions or visit the Rezūm service page. EAU treatment guidance.

FAQ

1)Is Rezum a surgery?

Rezūm is a minimally invasive procedure performed through the urethra without a skin incision.

2)Is TURP the same as prostate shaving?

The website uses TURP and prostate shaving to describe transurethral removal of the obstructing prostate tissue.

3)When is open prostatectomy used?

It may be used for very large prostates, severe complications, or situations requiring open surgical access.

4)Is radical prostatectomy used for BPH?

Radical prostatectomy is described as a cancer surgery that removes the whole prostate.

5)Can prostate surgery affect ejaculation or erections?

Yes. The risk depends on the type of surgery and patient factors.

Learn more about minimally invasive Rezum therapy for enlarged prostate.