Does benign prostatic hyperplasia always require surgery? Will treatment affect sexual function?

As men age, changes in male hormone levels can cause gradual enlargement of the prostate gland, a condition known as benign prostatic hyperplasia (BPH). As the prostate enlarges, it may compress the urethra and interfere with normal urine flow. In the early stages, symptoms often include slower urination and a sensation of incomplete bladder emptying. If left unaddressed, BPH may progress and lead to reduced bladder function and, in severe cases, impaired kidney function. In fact, there are multiple treatment options available, ranging from observation and medication to minimally invasive procedures. With early evaluation and appropriate management, most patients can find a safe and effective treatment that improves urinary symptoms while preserving quality of life.

Benign prostatic hyperplasia (BPH) is one of the most common urological conditions affecting men over the age of 50. Studies show that approximately half of men at age 50 experience varying degrees of lower urinary tract symptoms (LUTS). However, having an enlarged prostate does not automatically mean surgery is required. Treatment decisions are based on a comprehensive clinical assessment, including the following factors:

💬 Symptom severity: Such as frequent urination, nocturia, urinary retention, or a weakened urine stream.

💬 Response to medication: Surgery is considered only if long-term medical therapy fails to improve symptoms or causes significant side effects.

💬 Risk of complications: Further intervention may be necessary if complications occur, including hematuria, recurrent urinary tract infections, or kidney impairment.

Through tests such as uroflowmetry, ultrasound, cystoscopy, and PSA testing, urologists can accurately assess prostate size, urinary function, and obstruction severity. The key principle is to identify the underlying cause and tailor treatment accordingly, rather than proceeding directly to surgery.

Mild symptoms of benign prostatic hyperplasia (BPH) can often be significantly improved through simple lifestyle modifications.

Urologists commonly recommend the following strategies:

In addition, maintaining a healthy body weight and avoiding prolonged sitting may help reduce pressure on the prostate. If symptoms such as nocturia more than twice per night, difficulty urinating, or a feeling of incomplete bladder emptying are already present, early consultation with a urologist is recommended.

Current clinical treatments for benign prostatic hyperplasia (BPH) can be broadly divided into three main categories:

📋 Medication Therapy

Medication is typically recommended for patients with mild to moderate symptoms. Common medications include alpha-blockers and 5-alpha-reductase inhibitors, which help relax the urinary tract or reduce prostate volume to improve urine flow.

📋 Conventional Surgical Treatments

Traditional procedures such as transurethral resection of the prostate (TURP) or laser prostate surgery have well-established effectiveness. However, these are heat-based procedures and may be associated with postoperative irritation or discomfort in some patients.

📋 Minimally Invasive Aquablation Therapy

Aquablation Therapy is an advanced, minimally invasive technique that uses a high-pressure, heat-free water jet to precisely remove excess prostate tissue. The procedure is guided by real-time cystoscopic and ultrasound imaging, with robotic and computer-assisted control to enhance accuracy and consistency. Its key advantages include being heat-free, precise, and tissue-sparing, which helps effectively relieve urinary symptoms while reducing the risk of nerve and surrounding tissue injury.

International clinical studies have shown that Aquablation Therapy not only improves urinary symptoms but also helps preserve sexual function and overall quality of life, with a shorter recovery period, making it an important treatment option for patients with moderate to large prostate enlargement.

Benign prostatic hyperplasia is not a condition that should be ignored as a normal part of aging. Symptoms such as frequent urination, nocturia, and weak urine flow, if left untreated, may progress and lead to more serious urinary tract problems.

Tungs’ MetroHarbor Hospital has achieved JCI international medical quality accreditation, signifying that we meet international medical standards in patient safety, medical procedures, infection control, and quality management, and are continuously subject to rigorous scrutiny. Our urology team combines the experience of professional physicians with precise treatment techniques, and receives cross-border medical assistance from FORMOSA TUNGS+ IMedS International Medical Center. From medical assessment and treatment planning to post-operative follow-up, patients from different countries can clearly understand the process and receive care with peace of mind.