Is surgery necessary for an enlarged prostate? When can you avoid it, and when should you consider surgery?

Being told by a doctor, "You have an enlarged prostate, and surgery could be considered," many people's first reaction is: Has it really come to this point?

To give you the conclusion first: Not necessarily. Most cases of benign prostatic hyperplasia (BPH) do not require surgery; starting with medication and regular follow-ups is the standard clinical medical recommendation. However, there are several situations where surgery indeed has a clear and necessary reason to be performed.

This article will clearly explain the boundary between "you can hold off on surgery for now" and "you should seriously consider it," so that you are mentally prepared when discussing it with your doctor.

Why does "enlarged" not equal "requiring surgery"?

Because prostate volume and symptom severity do not necessarily correlate directly.

Some people have a large prostate but only mild symptoms, while others have a prostate that isn't particularly large but experience severe obstruction at the bladder outlet. What determines the intensity of clinical treatment is the impact of symptoms on your life, your response to medication, and whether any complications have arisen, rather than just looking at the data from various medical examinations. Therefore, the answer to the question "Do I absolutely need surgery?" still goes back to your own symptoms.

If you are still not sure whether your condition is benign prostatic hyperplasia, please first read "What are the symptoms of an enlarged prostate? When to see a doctor and which warning signs can't wait."

In what situations can we hold off on surgery first?

If your symptoms are mild to moderate, you respond well to medication, and you do not have any of the warning signs listed in the next section, holding off on surgery for now is an acceptable choice.

The standard approach at this stage is lifestyle adjustments combined with medication therapy, along with regular follow-up visits. The follow-up items are actually very specific: changes or improvements in symptoms, post-void residual urine volume, kidney function indices, and whether there are recurrent infections. As long as these indicators gradually stabilize, it is not uncommon for patients to coexist peacefully with an enlarged prostate for many years.

A friendly reminder here is that medication may need to be taken long-term, and some drugs have side effects such as dizziness (postural hypotension) or issues related to ejaculation. If you have any related concerns, please discuss them with your doctor for adjustments, and do not stop taking the medication on your own.

Are there any prostate treatments that do not go through the urethra?

Yes. Most common surgeries for benign prostatic hyperplasia, such as transurethral resection of the prostate (TURP) or laser surgery, access the prostate through the urethra. However, there is another treatment performed through the arterial blood vessels called prostate artery embolization (PAE), which does not involve the urethra at all throughout the entire procedure.

In PAE, the doctor inserts a microcatheter through an artery in the wrist or groin, and under the guidance of an angiography imaging machine, selectively embolizes the arteries supplying the prostate. This gradually shrinks the volume of the gland, thereby improving urinary symptoms. Because it does not go through the urethra and involves no tissue resection, the instruments do not pass through the penis or touch the external genitalia during the process. People who are anxious about instruments entering through the urethral opening, prefer not to have vital areas touched during treatment, are concerned about surgery-related impacts like retrograde ejaculation, or face higher anesthesia risks, can consider PAE as another pathway to discuss with their doctor.

There is also another concern that is less often voiced out loud. Transurethral surgery typically requires spinal or general anesthesia. Some people feel anxious just thinking about instruments entering private areas of their body while they are asleep or when their lower body is numb, or worrying that their genitals might bleed.
PAE is performed under local anesthesia, so you remain fully awake throughout the procedure. The instruments enter through an artery in the wrist or groin and do not go through the urethra. If you have any sensations or questions during the process, you can communicate them directly with the doctor right then and there.

However, PAE is not suitable for everyone, nor is it a complete replacement for surgery. Prostate volume, vascular conditions, and symptom severity will all affect suitability, and some situations are still best managed with surgery. If you want to thoroughly compare the differences between transurethral surgery, laser surgery, and PAE, you can refer to the complete comparison of various treatment methods on our website, or have a doctor evaluate and explain them to you.

In what situations is surgery recommended?

There are five situations where considering surgery is clinically justified.

1. Recurrent acute urinary retention: Completely unable to urinate; even after placing a urinary catheter and removing it, still unable to urinate.
2. Long-term obstruction that has already affected kidney function.
3. Recurrent hematuria (blood in urine).
4. Recurrent urinary tract infections or the formation of bladder stones.
5. Symptoms still severely affect sleep and quality of life despite regular medication.

If you fall into these categories, please discuss treatment options seriously with your doctor and do not keep delaying. At this point, the focus is no longer on "whether you want surgery," but rather on the fact that the symptoms themselves are causing harm to your body.

If I really don't want surgery, are there other options in between?

Between "medication having limited effect" and "transurethral surgery," there is also Prostate Artery Embolization (PAE), which does not go through the urethra: it uses a microcatheter via the arteries to embolize the blood vessels supplying the prostate, gradually shrinking its volume.

PAE is one of the options, but it is not suitable for everyone.
The volume, anatomy, and vascular conditions of the prostate will all affect whether this minimally invasive treatment can be performed, which requires a urological evaluation combined with imaging examinations to determine.
If you would like to understand the procedure and eligibility criteria of prostate artery embolization itself, please refer to "PAE Prostate Artery Embolization Treatment Guide"; for a complete comparison on how to choose between surgery and PAE, please see "PAE Prostate Artery Embolization vs. Other Surgical Methods Comparison".

Before discussing with a doctor, what information is most efficient to prepare?

It is recommended to prepare five pieces of information: how long the symptoms have lasted, how many times you wake up at night to urinate, your score if you have taken the International Prostate Symptom Score (IPSS), your current medication list and how long you have been taking them, and whether you have ever experienced an inability to urinate, hematuria, or infections.

These five answers directly determine whether you fall into the "can hold off for now" or "should consider surgery" category, and they also allow your consultation time to be spent discussing options rather than reconstructing your medical history.

What if you would like an evaluation?

First, a reminder about something that cannot wait: if you are currently completely unable to urinate, please go directly to a clinic or emergency room; do not wait for an outpatient appointment.

For other situations, you can first complete a preliminary assessment via LINE to arrange for the Men's Special Clinic on Saturdays. When you come for your appointment, please bring your past medical reports and medication list, so you can evaluate your situation along with the doctor based on the boundaries discussed in this article.

The Sunrise Clinic is located at 2F-1, No. 40, Sec. 2, Heping E. Rd., Da'an Dist., Taipei City. It operates entirely on an appointment-only basis. Phone: (02) 2366-0186.

Author: Dr. Chun-Yu Lin

Last Updated: August 18, 2026

Disclaimer: This article is for health education purposes only and cannot replace professional medical diagnosis and treatment advice. The suitability of any treatment must be evaluated and decided by a physician.

Prostatic Artery Embolization (PAE) International Literature References:
Mouli S, Dolmatch BL, Gunn AJ, et al. Society of Interventional Radiology (SIR) 2026 practice guidance document for prostatic artery embolization. J Vasc Interv Radiol. 2026;108771. doi:10.1016/j.jvir.2026.108771 Sapoval M, Thiounn N, Descazeaud A, et al. Prostatic artery embolisation versus medical treatment in patients with benign prostatic hyperplasia (PARTEM): a randomised, multicentre, open-label, phase 3 superiority trial. Lancet Reg Health Eur. 2023;31:100672. doi:10.1016/j.lanepe.2023.100672