Cared for by Dr Dimitri Gambachidze
Benign prostatic hyperplasia is a non-cancerous enlargement of the prostate that gradually obstructs the flow of urine. It is extremely common after fifty and, while not dangerous in itself, it can seriously disrupt sleep and daily life and eventually damage the bladder or kidneys. Treatment is chosen according to prostate volume, symptom severity, bladder function and personal priorities — including whether preserving ejaculation matters to you. Modern laser enucleation makes it possible to treat even very large prostates endoscopically, with no incision and a short catheter time.
The whole obstructing adenoma is peeled away from its capsule endoscopically and removed, exactly as in open surgery but without an incision. It is size-independent, gives the largest and most durable improvement in flow, and retreatment rates are very low.
Bipolar TURP or laser vaporisation remain excellent options for small to medium prostates, with a short hospital stay.
For men in whom preserving antegrade ejaculation is a priority, ejaculation-sparing enucleation or minimally invasive alternatives are discussed, with a realistic explanation of the trade-off in flow improvement.
Alpha-blockers, 5-alpha-reductase inhibitors and combination therapy are appropriate for moderate symptoms; their effect on ejaculation and libido is explained before starting.
Lasting incontinence is uncommon. Temporary urgency during healing is normal and settles over a few weeks.
Standard enucleation or resection causes retrograde ejaculation in most men — the sensation of orgasm is unchanged. If this matters to you, say so: ejaculation-preserving options exist.
No. Laser enucleation treats prostates of any volume, including those over 150 ml that once required open surgery.