For decades, men facing an enlarged prostate had limited choices: live with worsening symptoms, take medications indefinitely, or undergo invasive surgery with significant risks to sexual function. That era is over.
Today’s non-surgical and minimally invasive treatments for benign prostatic hyperplasia (BPH) offer effective prostate reduction with dramatically less downtime, fewer complications, and better preservation of quality of life. If you’re looking to avoid traditional surgery while still achieving meaningful relief, understanding your options is the first step toward reclaiming your comfort and freedom.
Why Men Are Seeking Non-Surgical Alternatives
Traditional prostate surgery—particularly TURP (transurethral resection of the prostate)—has been the gold standard for BPH treatment for decades. It’s effective at reducing prostate size and improving urine flow, but it comes with significant drawbacks:
- Hospital stays and general anesthesia
- Recovery periods of weeks to months
- Risk of retrograde ejaculation
- Risk of erectile dysfunction
- Potential for bleeding, infection, and incontinence
- Time away from work and normal activities
For many men, especially those who are sexually active or have demanding work schedules, these risks outweigh the benefits—at least until symptoms become unbearable. This creates a frustrating catch-22: wait until you’re desperate enough to accept surgery’s risks, or live with a deteriorating quality of life.
Fortunately, medical innovation has shattered this false choice. Non-surgical and minimally invasive options now allow men to address prostate enlargement earlier, with less risk and faster recovery.
Medications: The First-Line Non-Surgical Approach
Before exploring procedural options, most doctors recommend trying medications. While they require ongoing use, they’re completely non-invasive and can effectively manage symptoms for many men.
Alpha Blockers
Medications like tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo) work by relaxing muscles in the prostate and bladder neck. This improves urine flow without actually shrinking the prostate. These medications provide fast symptom relief—often within days to weeks—but must be taken daily indefinitely. Side effects can include dizziness, fatigue, and potential retrograde ejaculation.
Best for: Men with mild to moderate symptoms who want quick relief without procedures.
5-Alpha Reductase Inhibitors
Finasteride (Proscar) and dutasteride (Avodart) actually shrink the prostate by blocking DHT, the hormone driving prostate growth. They can reduce prostate volume by 20-30% over six to twelve months. However, it takes 3-6 months to notice improvement, and you must continue taking them indefinitely to maintain results. Sexual side effects—including reduced libido, erectile dysfunction, and decreased ejaculate volume—affect some men.
Best for: Men with larger prostates willing to wait months for results and who can tolerate potential sexual side effects.
Combination Therapy
For men with prostates larger than 40 grams, doctors often prescribe both an alpha blocker and a 5-alpha reductase inhibitor. This addresses immediate symptoms while working to shrink the prostate over time.
Minimally Invasive Procedures: The Modern Middle Ground
When medications aren’t effective, cause intolerable side effects, or you simply don’t want to take daily pills indefinitely, minimally invasive procedures offer compelling alternatives to traditional surgery.
Prostate Artery Embolization (PAE)
PAE represents one of the most innovative advances in BPH treatment. This procedure reduces prostate size by decreasing its blood supply, causing the enlarged tissue to gradually shrink.
How it works: An interventional radiologist makes a tiny incision (just a few millimeters) in your wrist or groin and guides a thin catheter through your blood vessels to the arteries feeding your prostate. Microscopic particles are injected to block blood flow to the enlarged prostate tissue. The entire procedure takes one to two hours, and you go home the same day.
Pros:
- Outpatient procedure with same-day discharge
- No incisions in the genital area
- Mild recovery (limit activity for two days)
- Very low risk of sexual dysfunction or incontinence
- Effective for large prostates
- Symptom improvement within 2-4 weeks
- Prostate shrinkage of 20-40% over 6-12 months
- Long-lasting results (years)
- Can be repeated if needed
Cons:
- Not as widely available as traditional surgery
- Temporary pelvic discomfort for a few days
- Not all insurance plans cover it yet (though coverage is expanding)
- Some men may not have suitable arterial anatomy, but that is uncommon
Best for: Men who want to avoid genital surgery, preserve sexual function, and achieve lasting results without daily medication. Particularly appealing for men with large prostates or those on blood thinners.
Recovery timeline: Most men return to desk work within 2-3 days and normal activities within a week. Medications help manage mild discomfort during the first few days.
Rezūm Water Vapor Therapy
Rezūm uses thermal energy from water vapor to destroy excess prostate tissue. The tissue is gradually absorbed by your body over the following weeks and months.
How it works: A transurethral device is inserted through the urethra. Sterile water vapor is injected into the prostate tissue in nine-second bursts. The procedure takes about five minutes and uses local anesthesia in an office setting.
Best for: Men with prostates under 80 grams who want to preserve sexual function and don’t mind temporary symptom worsening during healing. This procedure has a low risk of sexual side effects (under 10% for retrograde ejaculation, under 5% for erectile dysfunction) and doesn’t require permanent implants. However, urinary symptoms typically worsen for 2-4 weeks before improving, and a catheter may be needed for several days.
Recovery timeline: Most men need about two weeks of reduced activity. Urinary symptoms often worsen before improving, but significant relief typically appears within 2 weeks to 3 months.
UroLift
UroLift doesn’t remove or destroy prostate tissue. Instead, permanent implants hold the prostate lobes away from the urethra, like pulling back curtains to open a passageway.
How it works: Small implants are placed through a cystoscope to lift and hold enlarged prostate tissue out of the way. Typically 4-6 implants are used during this office-based procedure with local anesthesia.
Best for: Men with small to moderate prostates (under 80 grams) without middle lobe enlargement who prioritize rapid recovery and sexual function preservation. UroLift offers the fastest symptom relief among minimally invasive options—often immediate to two weeks—and has the lowest risk of sexual side effects (0-5% retrograde ejaculation, 1-3% erectile dysfunction). However, it provides minimal actual prostate size reduction since tissue is repositioned rather than removed, and it cannot treat all prostate anatomies.
Recovery timeline: Most men resume normal activities within a few days.
Aquablation
Aquablation uses a high-velocity water jet guided by robotic imaging to precisely remove prostate tissue. It’s one of the newest FDA-approved treatments.
How it works: Robotic imaging maps your prostate, then a waterjet removes tissue under computer control. The procedure takes about 10 minutes of active treatment and requires anesthesia, often with an overnight hospital stay.
Best for: Men who want a precise, imaging-guided procedure and are comfortable with a more invasive approach than other minimally invasive options. Aquablation offers lower ejaculatory dysfunction rates than TURP while effectively treating a wide range of prostate sizes, though it carries a higher risk of bleeding than PAE, Rezūm, or UroLift.
Recovery timeline: About 1-2 weeks for initial recovery, with catheter for several days.
Laser Procedures (GreenLight, HoLEP)
Various laser technologies vaporize or remove prostate tissue with less bleeding than traditional surgery.
How it works: A laser fiber is inserted through the urethra to either vaporize (GreenLight) or cut and remove (HoLEP) prostate tissue. These procedures require anesthesia and typically involve same-day or overnight hospital stays.
Best for: Men with very large prostates who want to avoid traditional surgery but accept more invasive intervention than newer minimally invasive options. Laser procedures are particularly good for patients on blood thinners due to reduced bleeding risk. However, they carry moderate to high retrograde ejaculation rates (20-30% for GreenLight, up to 75% for HoLEP) and require catheterization for several days post-procedure.
Recovery timeline: 2-4 weeks until return to normal activities.
Comparing Effectiveness: What the Data Shows
When evaluating non-surgical options, effectiveness matters. Here’s how these treatments compare:
Symptom improvement:
- All of these treatments show significant symptom improvement, typically 40-60% reduction in symptom scores
- PAE, Rezūm, and laser procedures show comparable symptom relief to TURP
- UroLift shows good but slightly less dramatic improvement than tissue-removing procedures
Prostate size reduction:
- PAE: 20-40% reduction
- 5-alpha reductase inhibitors: 20-30% reduction
- Rezūm: Moderate reduction (tissue destroyed and absorbed)
- UroLift: Minimal actual size reduction (tissue repositioned, not removed)
- Laser procedures: Significant reduction (tissue removed)
Durability of results:
- Medications: Effective only while taking them
- PAE: Results lasting 3-5+ years in studies; long-term data still accumulating
- Rezūm: Good durability in 5-year studies
- UroLift: Good results through 5 years; some men may need retreatment
- Laser procedures: Excellent long-term durability
Sexual Function Preservation: A Critical Factor
For many men, preserving sexual function is a top priority. Here’s how non-surgical options compare:
Erectile function:
- PAE: Very low risk (under 5%)
- Rezūm: Low risk (under 5%)
- UroLift: Very low risk (1-3%)
- Medications (alpha blockers): Low risk
- Medications (5-ARIs): Moderate risk (10-15%)
- Laser procedures: Low to moderate risk depending on technique
Ejaculatory function:
- PAE: Very low risk of retrograde ejaculation (under 10%)
- Rezūm: Low risk (5-10%)
- UroLift: Very low risk (0-5%)
- Alpha blockers: Low to moderate risk
- Laser procedures: Moderate to high risk (20-75% depending on technique)
- Traditional TURP: High risk (65-75%)
If maintaining ejaculatory function is important to you—whether for fertility or personal preference—PAE, Rezūm, and UroLift offer the best preservation rates.
Insurance Coverage and Cost Considerations
Understanding the financial aspect is crucial when choosing a treatment, as coverage varies significantly across non-surgical BPH options.
Generally well-covered:
- Medications (often with generic options)
- Traditional TURP
- Laser procedures at many centers
Coverage expanding:
- PAE: Increasingly covered by Medicare and major insurers,
- Rezūm: Growing coverage; Medicare approved
- UroLift: Medicare and most major insurers cover it
- Aquablation: Coverage varies
Before choosing a treatment, verify coverage with your insurance provider. Some men find that even with partial coverage or out-of-pocket costs, non-surgical options are worth it for the reduced risk and faster recovery.
Many centers offer payment plans for procedures not fully covered by insurance. Don’t let cost be the only factor—consider the value of preserved sexual function, faster recovery, and fewer complications.
Real Patient Priorities: What Matters Most?
When surveyed, men with BPH consistently rank these factors as most important:
Preserving sexual function: The number one concern for most men under 70
Avoiding a catheter: Many men find the idea of catheterization particularly unpleasant
Minimizing recovery time: Especially for men still working or with active lifestyles
Effectiveness and durability: Will it actually work, and for how long?
Avoiding repeat procedures: Wanting a one-time solution
PAE and Rezūm score particularly well on these patient-centered priorities, which explains their growing popularity. They offer an attractive balance of effectiveness, safety, sexual function preservation, and reasonable recovery time.
The Bottom Line: You Have Options
If you’re experiencing symptoms from an enlarged prostate, you no longer face the stark choice between medication forever or invasive surgery. Non-surgical and minimally invasive options now provide a spectrum of choices that can match your specific situation, priorities, and comfort level.
Consider starting with this approach:
Assess your symptoms: Use a validated tool like the International Prostate Symptom Score (IPSS) to objectively measure severity.
Consider medications: If symptoms are bothersome but manageable, medications may be sufficient.
Explore minimally invasive procedures: If medications fail, cause side effects, or you want a more definitive solution.
Reserve traditional surgery: For cases where minimally invasive options have failed or aren’t suitable.
The key is not waiting until you’re desperate. Addressing your enlarged prostate earlier—when minimally invasive options are most effective—often leads to better outcomes and preserves more function.
Schedule consultations with both a urologist and an interventional radiologist to hear about different treatment perspectives. Ask about their experience with various procedures, success rates, and complication rates. Most importantly, ensure they understand what matters most to you—whether that’s preserving sexual function, minimizing downtime, or achieving the most durable results.
Your enlarged prostate doesn’t have to mean accepting either declining quality of life or invasive surgery. In 2025, the middle ground is broader and more effective than ever. Take advantage of these modern options to reclaim your comfort, your sleep, and your freedom—without the risks and recovery time of traditional surgery.
The first step is simple: reach out to a specialist who offers multiple treatment options and start the conversation about which approach aligns best with your goals. Relief is within reach, and it doesn’t require the sacrifices it once did.
Learn more about Prostate Artery Embolization (PAE) or request a consultation. Colorado Advanced Endovascular is based in Lakewood, Colorado, and serves Denver and the Front Range.