An enlarged prostate has more than one answer. We match the treatment to your anatomy and your goals, from office procedures to robotic surgery, with the least disruption possible.
Medically reviewed by Hari Sawkar, MD, board-certified urologist · Updated August 2026
Benign prostatic hyperplasia (BPH) is a normal part of aging for many men. As the prostate grows, it presses on the urethra and makes everyday life harder than it should be. It is common, it is not cancer, and it is very treatable. Dr. Sawkar evaluates and treats enlarged prostates for men across Orange County from his Santa Ana office. If nighttime trips are the loudest symptom, start with why you wake up at night to pee.
They differ in recovery, anesthesia, and whether they are done in the office or the hospital. We will walk through them together and choose what fits.
Prostate artery embolization shrinks the prostate by gently reducing its blood supply, through a catheter no wider than a strand of spaghetti placed in the wrist or groin. The prostate itself is never cut.
Tiny permanent implants lift the enlarged tissue away from the urethra and hold it open, like tiebacks on a curtain. No prostate tissue is removed, heated, or cut.
Targeted water vapor is released into the prostate, where stored heat energy causes the excess tissue to shrink over the following months as the body reabsorbs it.
A robotically controlled, heat-free waterjet removes excess prostate tissue with real-time imaging and precision. Dr. Sawkar has performed more than 250 of these, more than any surgeon in Orange County.
Dr. Sawkar offers all four, which is rare for one practice. That means the comparison below is a menu, not a sales pitch.
| PAE | UroLift | Rezūm | Aquablation | |
|---|---|---|---|---|
| Setting | Outpatient, home same day | Office | Office | Hospital, usually one night |
| Anesthesia | Light sedation | Local | Local, with light sedation | Spinal or general |
| Catheter afterward | Usually none | Usually none | Temporary, a few days | One to two days |
| Back to routine | About a day | Within days | A few days | One to two weeks |
| What happens to the tissue | Shrinks over 4 to 12 weeks | Held open by implants | Reabsorbed over months | Removed robotically |
| Notable strength | Works for nearly any size, including very large glands | Fastest office recovery, nothing removed | No implants, durable five-year data | Surgical-grade result at any size |
General patterns, not a guarantee. Your anatomy, medications, and goals can change the picture, which is exactly what the consultation sorts out.
Prostate size and shape, measured by a quick in-office ultrasound, narrow the menu before preferences even enter the conversation. The patterns below are where each option does its best work. Not sure what your number means? Start with the prostate size chart.
UroLift and Rezūm do their best work between roughly 30 and 80 cc: brief office visits, fast recovery, and ejaculation preserved in most men.
Above 80 to 100 cc, prostate artery embolization (PAE) and Aquablation take over. Both stay effective where the office options reach their design limits, and PAE has no practical upper size limit.
Tissue growing up into the bladder changes the plan. Rezūm, Aquablation, and PAE all handle a median lobe; imaging confirms yours before any recommendation.
UroLift and PAE preserve ejaculation in the large majority of men, and Aquablation was designed to spare it during surgical-grade tissue removal.
PAE uses no general anesthesia and suits men who cannot stop blood thinners, which keeps it open to men who have been turned away from surgery.
Getting off a catheter calls for decisive relief of the blockage. Aquablation and PAE both offer a path back to natural voiding; size and overall health decide between them.
The International Prostate Symptom Score is the same seven-question measure urologists use in the clinic. Answer for the past month on a 0 to 5 scale, where 0 means not at all and 5 means almost always; for the nighttime question, 0 means no trips and 5 means five or more. Bring your score to your visit.
Many men start with medication. Alpha blockers relax the muscle around the urethra and can ease the stream within days, while 5-alpha-reductase inhibitors shrink the gland itself over several months. Both manage symptoms rather than fix the blockage, and dizziness, fatigue, and sexual side effects lead plenty of men to ask what else is possible. If that is where you are, see the alternatives to Flomax, from smarter pills to the four procedures below.
There is also a quieter reason not to wait indefinitely. A bladder that strains against a blocked urethra for years thickens, then weakens, and some of that change does not reverse. Treating the obstruction at the right time protects the bladder you will rely on for decades. A few signs mean the evaluation should happen promptly:
TURP, the traditional surgery, remains the benchmark the newer options are measured against: effective, durable, and still the right call for some men. It also means a hospital stay, a catheter, and retrograde ejaculation for most, which is exactly what the four options above were designed to avoid.
For very large glands, laser enucleation (HoLEP) or, rarely, open surgery can be the honest answer. This practice is built on matching the treatment to the anatomy, and when traditional surgery is genuinely the better path, you will hear that too. See how PAE compares with TURP.
All four treatments, PAE, UroLift, Rezūm, and Aquablation, are typically covered by Medicare and most PPO and commercial plans when BPH symptoms are documented. What you actually pay depends on your deductible, coinsurance, and whether you carry a Medicare supplement, so the office verifies benefits and walks you through the numbers before anything is scheduled. Office-based and outpatient options also avoid the hospital facility charges that come with traditional surgery, which is one reason the gentler paths are often the lighter bill as well.
We review your symptom score, medications, and imaging, measure the prostate if it has not been measured, and talk through the options honestly, including the ones we would skip and why.
UroLift and Rezūm happen in the office, PAE in the practice's own outpatient lab, and Aquablation in the hospital with Orange County's highest-volume surgeon. You will know exactly what yours involves before the day arrives.
A clear, realistic timeline for getting back to normal, from about a day for PAE to a week or two for Aquablation, with telehealth follow-up whenever that is easier.
A UroLift Center of Excellence, and Orange County's highest-volume Aquablation surgeon.
Yes. PAE, UroLift, Rezūm, and Aquablation are all typically covered by Medicare and most PPO and commercial insurance plans when BPH symptoms are documented. The office verifies your coverage before any procedure and explains any out-of-pocket cost.
PAE and Aquablation are the strongest options for very large glands. UroLift and Rezūm are designed for small to moderate sizes, which is one reason an accurate prostate measurement comes before any recommendation.
No, though many men arrive already taking one. Alpha blockers and similar medications can ease symptoms, but they treat the squeeze rather than the size, and side effects like dizziness and sexual dysfunction lead many men to look for a longer-term answer. A consultation lays out both paths honestly.
It depends on the procedure, and it is usually the first question men ask. UroLift and PAE preserve ejaculation in the large majority of men, Rezūm does so at somewhat lower rates, and Aquablation was designed to protect sexual function during surgical-grade tissue removal. Dr. Sawkar walks through the numbers for each option at your visit.
No. BPH is benign growth and does not turn into prostate cancer. The two conditions can exist at the same time, though, so the evaluation includes a PSA review to be sure nothing else needs attention.
When symptoms interfere with sleep, work, travel, or peace of mind, or when the bladder stops emptying well. Waiting too long can stretch the bladder and weaken it permanently, so bothersome symptoms deserve an evaluation even if you are not ready for a procedure.
The bladder pays the price. Pushing against a blocked urethra thickens and then weakens the bladder muscle, and over years that can mean retention, infections, bladder stones, or pressure on the kidneys. Treating the obstruction at the right time protects function that does not always come back.
With imaging, usually a quick in-office ultrasound, sometimes an MRI you already have. Size and shape, including whether a median lobe is present, are measured before any recommendation, because they decide which options fit.
The prostate keeps aging, so some regrowth over the years is possible with any option. UroLift implants keep holding tissue open, Rezūm and PAE can both be repeated, and Aquablation removes tissue durably. If symptoms ever return, nothing about a first treatment closes the door on a second.
UroLift, about a day or two. PAE, most men are back at work in a day or two while symptoms improve over the following weeks. Rezūm, a few days with a short-term catheter. Aquablation, one to two weeks with a night in the hospital. None of them involve the month-long recovery of traditional open surgery.
Same-day and next-day appointments for urgent concerns. Medicare and most PPO plans accepted, and telehealth consultations available. For the fastest response, send the office a secure message; the reply comes back by text.
Chief of Urology, Providence St. Joseph Hospital · UroLift Center of Excellence · Orange County's highest-volume Aquablation surgeon