Confirm that prostate obstruction is the main problem
Lower urinary tract symptoms can come from several causes. Heidelberg describes assessment with history, examination, PSA when appropriate, ultrasound, residual urine and uroflowmetry, with pressure-flow studies used in selected cases to document outlet obstruction. A procedure should follow this assessment rather than being chosen from prostate size or marketing alone.
Treatment intensity should match symptoms and complications
Charité describes lifestyle measures for mild symptoms, medication for moderate to severe symptoms and operative treatment when symptoms remain burdensome or complications such as increasing residual urine or acute retention occur. The decision should also consider bladder function, infections, stones and kidney drainage.
Medication is a legitimate treatment pathway, not a delay before surgery
Charité and Heidelberg describe medical treatment for symptomatic BPH. Depending on the clinical situation, medicines can relax prostate and bladder-neck smooth muscle or reduce prostate growth over time. Choice and combination depend on symptom pattern, prostate characteristics, blood pressure, sexual side effects and other medication.
HoLEP and ThuLEP remove obstructing tissue endoscopically
Freiburg describes holmium- and thulium-laser enucleation for benign prostate enlargement. These procedures remove the obstructing inner prostate tissue through the urethra, allow tissue to be sent for histology and can be used across a broad range of prostate sizes in experienced centers.
TUR-P and other minimally invasive options still have roles
Heidelberg and Charité document TUR-P as an established transurethral operation, while Charité also offers other options such as GreenLight vaporization, REZUM and selected prostate-artery embolization assessment. These techniques differ in anesthesia, bleeding profile, durability, recovery, sexual side effects and whether tissue is available for pathology.
Acute urinary retention or infection with obstruction needs local care
A patient who cannot pass urine, has fever with suspected urinary obstruction, severe uncontrolled pain or acute kidney-function deterioration should be assessed promptly where they are. Planned medical travel is appropriate only after urgent problems are stabilized.
What to send for a German BPH review
A remote review is more useful when it includes objective urinary-function information rather than symptoms alone.
- Symptom history and previous medication trials
- Prostate volume from ultrasound or MRI if available
- PSA history and previous biopsy information when relevant
- Uroflowmetry and residual-urine measurements if performed
- History of urinary retention, infection or bladder stones
- Cystoscopy or urodynamic reports when already available
- Current medication including anticoagulants
- A specific question: continue medication, assess HoLEP/ThuLEP, TUR-P or another procedure
Official sources
Sources last checked 2026-09-12. Confirm current eligibility, procedure details and hospital requirements directly with the treating urology team.