I will explain, simply and clearly, what side effects you can expect after endoscopic treatment for prostate adenoma (benign prostatic hyperplasia, BPH). The goal of these procedures is always the same: to reduce prostatic compression to improve urinary flow. However, each technique has its own advantages, limitations, and specific side effects.
Why treat a prostate adenoma?
When medication becomes insufficient and quality of life deteriorates (weak urine stream, frequent urges, infections, or urinary retention), an endoscopic procedure is often necessary to restore normal urination. The choice of treatment depends on several factors: the severity of symptoms, the size and anatomy of the prostate, age, and priorities regarding sexual function.
Endoscopic options and their mechanisms
Laser resection (conventional technique)
Prostate resection, sometimes referred to as “scraping” in everyday language, is now primarily performed using lasers, particularly Holmium (HoLEP) or other enucleation/ablation lasers. The principle is to remove the obstructing portion of the prostate to free the urethra and improve urinary flow.
Advantages: significant and lasting efficiency, often optimal jet improvement.
A major drawback is the almost systematic occurrence of retrograde ejaculation. After the procedure, the ejaculatory ducts open towards the bladder and no longer towards the urethra. The ejaculate then “flows back up” into the bladder and is no longer expelled during orgasm.
Minimally invasive treatments: Rezūm and UroLift
Rezūm uses steam to reduce prostate volume, while UroLift places small implants to separate the prostate lobes and clear the urethra.
Benefits :
- They improve urinary flow, often enough to restore noticeable comfort.
- They preserve ejaculation in the vast majority of cases: Rezūm about 95% preservation, UroLift about 99%.
Disadvantages:
- The effect is slightly less pronounced than laser resection in some patients.
- Duration of effectiveness generally shorter, on average 5 to 10 years, compared to 15 to 20 years for laser resection.
- Perineal pain is possible, more frequent after UroLift than Rezūm.
Side effects common to all endoscopic treatments
Regardless of the technique chosen, some side effects may occur. These are generally temporary and disappear within a few weeks to a few months.
- Urinary bleeding , often slight and temporary.
- Hemospermia : blood in the semen while it is still being ejaculated outside, common in the weeks that follow.
- Urinary tract infections : treated with antibiotics if necessary.
- Local discomfort or pain lasting from a few days to a few weeks, depending on the technique.
Most of these effects disappear spontaneously between one and three months, depending on the intervention and individual sensitivity.
How to choose between these techniques?
The decision must be personalized. Here are the criteria I always consider:
- Priority to preserving ejaculation: favor Rezūm or UroLift if maintaining ejaculation is important.
- Seeking the most durable solution possible: laser resection offers the best longevity (15 to 20 years) and often a superior urinary result.
- Prostate size and anatomy: some large prostates or those with a particular architecture are better suited to laser resection.
- Tolerance to the risk of reintervention: minimally invasive techniques may require a new procedure sooner.
- Perineal pain and recovery: expect a higher risk of perineal discomfort with UroLift.
Practical points and recommendations
- Discuss your sexual and urinary priorities clearly with your urologist.
- Inform us if you are taking anticoagulants or have a risk of bleeding.
- Expect temporary post-operative symptoms (blood in urine or semen, mild pain, risk of infection).
- Most side effects subside within 1 to 3 months.
Conclusion
There is no single solution for everyone. Laser resection remains the most effective and long-lasting technique, but it very often results in retrograde ejaculation. Minimally invasive options like Rezūm and UroLift offer excellent preservation of ejaculatory function, at the cost of a sometimes less lasting effect and a risk of perineal pain. The right choice depends on your priorities, prostate anatomy, and a discussion with your urologist.
If you would like help weighing the pros and cons in your situation, I can explain in detail what would be best.