If symptoms are mild and no complications exist, you may not need medical treatment at all—simple changes can go a long way.
Choosing the Right BPH Treatment: What Men Need to Know
You’re getting up too many times at night.
Your stream is slowing down.
Maybe you’ve even had a close call trying to reach the toilet in time.
Your GP or urologist tells you that you’ve got BPH—a benign enlarged prostate. But with so many treatment options—tablets, laser, steam, surgery—how do you know which one is right for you?
In today’s edition, we break it down so you can make a confident, informed decision.
A Message From Dr. Charles Chabert
I’m Dr. Charles Chabert, urologist and Director of The Prostate Clinic on the Gold Coast, Australia.
For more than 20 years, I’ve helped men navigate treatment choices for urinary symptoms caused by benign prostate enlargement.
If you find this newsletter helpful, please share it with someone who might benefit.
What Exactly Is BPH?
BPH (Benign Prostatic Hyperplasia) simply means benign enlargement of the prostate.
The prostate sits beneath the bladder, shaped like a donut. Your urine pipe runs straight through the centre. As men age, the prostate grows—and that growth squeezes the pipe.
Common symptoms include:
Slower urinary stream
Increased daytime frequency
Urgency
Getting up multiple times overnight
Occasional near-accidents
Did you know?
Around 70% of men aged 70 will experience urinary issues related to BPH.
Step 1: Understand Your Symptoms & Your Risk
Before choosing a treatment, your doctor needs to determine whether your symptoms are:
Uncomplicated
Annoying, inconvenient, or frustrating—but not dangerous.
Complicated
When the prostate obstruction begins affecting bladder or kidney health.
To work this out, your urologist may do:
Ultrasound
Flow-rate testing
Bladder scan
Occasionally a cystoscopy (a small camera into the bladder)
How much do your symptoms bother you?
Mild
Increasingly irritating
Significantly affecting quality of life
If symptoms are mild and no complications exist, you may not need medical treatment at all—simple changes can go a long way.
Step 2: Lifestyle Approaches
These remain first-line for many men:
Reduce evening fluids
Avoid tea, coffee, or fizzy drinks after 5 p.m.
Consider cutting back on evening alcohol
Bladder retraining (don’t rush back to the toilet after urinating)
These changes can noticeably reduce urgency and night-time trips.
Step 3: Medication Options
1. Alpha Blockers
Relax the prostate and bladder neck to improve flow.
Pros:
Quick relief
Fully reversible
Cons:
Mild dizziness
Nasal stuffiness
Retrograde ejaculation can occasionally occur
2. 5-Alpha Reductase Inhibitors
Shrink the prostate over time—best for larger glands.
Cons:
Possible erectile or ejaculatory side effects
Takes months to work
DO YOU HAVE A QUESTION?
Dr Chabert will be hosting a Q&A on TUESDAY 23RD DECEMBER 7:30pm AEST on his YouTube channel, covering everything you need to know about prostate health, treatments, surgery, recovery & more!
Become a premium subscriber - Don’t miss your chance to be heard.
Step 4: Procedure Options
Procedures fall into two broad categories:
Minimally Invasive Treatments
Rezum (steam therapy)
UroLift
iTind
However, they’re not ideal for men with:
Very large prostates
An obstructing median lobe (UroLift/iTind less effective)
2. Definitive (Cavitating) Procedures
These create a wider, permanent channel through the prostate.
Includes:
GreenLight laser
HoLEP
TURP
Robotic simple prostatectomy (for very large prostates)
These offer stronger, longer-lasting results—but carry a much higher likelihood of ejaculatory changes.
The Real Decision: What Do You Value Most?
There is no single perfect treatment that:
Improves symptoms like a 20-year-old
Lasts forever
Has zero impact on ejaculation
Has zero risk to erections
So you must choose based on your priorities:
Men who dislike medication →
Minimally invasive options work well.
Men who want no downtime →
Rezum, UroLift, or iTind.
Men with a big prostate (80–100cc+) →
GreenLight, HoLEP, or TURP are usually more appropriate.
Men who want to preserve ejaculation at all costs →
Leaning toward minimally invasive treatments.
Men who want the strongest, longest-lasting improvement →
Cavitating surgery.
The Bottom Line
Choosing the right treatment depends on:
Prostate size
Prostate shape
Your lifestyle priorities
Your tolerance for side effects
Your preference for durability vs. invasiveness
The best pathway emerges when you and your urologist discuss your goals openly.
There’s always a trade-off—but together, you can find the option that fits you best.