Benign Prostatic Hyperplasia (BPH) - Surgery

Surgery

If you have difficulty urinating because of benign prostatic hyperplasia (BPH), you probably will not need surgery unless you:

• Cannot urinate. About half of the men who cannot urinate need catheterization. In catheterization, a tube is passed up the penis into the bladder and urine is drained. Half of these will be able to urinate again after catheterization. Those who do not improve may need surgery.
• Have a partial blockage in your urethra that is causing repeated urinary tract infections, bladder stones, or bladder damage.
• Have blood in your urine that is not getting better.
• Have kidney damage.

If you have no complications but have symptoms that bother you or if other treatment has not worked, you may choose to have surgery. In this case, consider:

• How much you expect the surgery to improve your symptoms.
• How severe your symptoms are.
• How you feel about the risk of developing a complication because of the surgery.

For more information on this decision, see:

Should I have surgery or use medication to treat benign prostatic hyperplasia?

Surgery Choices

The oldest surgical method to treat BPH is an open prostatectomy, in which an incision is made through the skin to reach the prostate. Doctors use this method less often now, but it is still preferred if the prostate is very large.

Surgery that does not require an incision through the skin is usually used. The surgical instruments are passed up the urinary opening in the penis to the location of the prostate. This is described as a transurethral surgery of the prostate. The procedures most commonly performed are:

• Transurethral resection of the prostate (TURP), in which a portion of the prostate is removed.
• Transurethral incision of the prostate (TUIP), in which incisions are made in the prostate that cause it to press less on the urethra.
• Laser therapy (transurethral laser coagulation and transurethral laser vaporization), in which a laser is used to make incisions in or remove a portion of the prostate.
• Transurethral microwave therapy (TUMT), in which microwave energy is used to destroy a portion of the prostate through heating.
• Transurethral needle ablation (TUNA), in which a heated needle is used to destroy a portion of the prostate.
• Transurethral electrovaporization of the prostate, in which an electric current is used to destroy a portion of the prostate.

In some cases, these treatments have been studied for only a few years, so their long-term effectiveness is not yet known.

What To Think About

Surgery is the most reliable way to relieve symptoms; but it may not relieve all your symptoms, and it puts you at risk for certain surgical complications, including erection problems (erectile dysfunction). Other complications include the inability to control the release of urine (urinary incontinence) and ejaculation of semen into the bladder instead of out through the penis (retrograde ejaculation). The complication depends on which type of surgery is used.

Men who have severe symptoms often notice great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life, and they may want to think carefully before deciding to have surgery to treat BPH.

If you have decided to have surgery, or if there are clear medical reasons to have surgery, the best surgical option depends on the size and shape of your prostate and the experience of the surgeon.

• Transurethral resection of the prostate (TURP) is the most common surgery for BPH.
• Transurethral incision of the prostate (TUIP) is most effective for men with smaller prostates. It has fewer risks and a shorter recovery period than TURP, and it appears to be nearly as effective in relieving symptoms.