While medications help many men with an enlarged prostate -- also called benign prostatic hyperplasia (BPH) -- they may not always be effective in relieving symptoms. You have other options in treating an enlarged prostate.
The Next Step in Treating Enlarged Prostate
Minimally invasive and surgical procedures are available to treat moderate-to-severe enlarged prostate symptoms that are bothersome. These procedures are also used if tests show that urinary function is seriously affected.
Each treatment has benefits and risks, and some treatments can help certain patients more than others.
As you discuss the options, ask your doctor these five questions:
- Is there a good chance my condition will improve?
- How much will it improve?
- What are the chances of side effects from a treatment?
- How long will the effects last?
- Will I need to have this treatment repeated?
Minimally Invasive Procedures for an Enlarged Prostate
Minimally invasive procedures for an enlarged prostate are often performed in a doctor's office. Overall these procedures are better than drugs at relieving symptoms, but they are less effective than surgery.
- Transurethral microwave therapy (TUMT). This procedure uses a microwave antenna attached to a flexible tube that is inserted into the bladder. The microwave heat destroys excess prostate tissue.
- Transurethral needle ablation (TUNA). This procedure uses a heated needle inserted into the prostate through the urethra to destroy excess prostate tissue.
- UroLift system. The UroLift system is the first permanent implant for BPH. It works by pulling back the prostate tissue that is pressing on the urethra and impeding urine flow.
Surgery for an Enlarged Prostate
Most men have tried medications for their enlarged prostate before discussing surgery. However, some men may wish to move directly to surgery if their symptoms are particularly bothersome. As with any treatment decision, it's important to fully discuss the risks and benefits with your doctor.
Surgery is often considered the best long-term solution for relief of BPH symptoms. Most surgical procedures involve removing the enlarged part of the prostate.
Surgery is usually recommended in treating BPH-related complications, such as:
- Urinary retention (inability to urinate)
- Failure to respond to medical or minimally invasive treatments
- Blood in the urine that is not getting better
- Bladder stones
- Frequent urinary tract infections
- Kidney damage
The surgical procedures include:
- Transurethral resection of the prostate (TURP). In this surgery, the inner portion of the prostate is removed. This is the most commonly used surgical procedure for BPH; it's used in 90% of BPH surgeries. And it's considered the best of endoscopic surgical treatments for enlarged prostate, although other surgical procedures are acceptable alternatives. No external scars are seen since the scope is inserted thorough the urethra.
- Open prostatectomy (open surgery). This surgery is often done when the prostate is greatly enlarged, when there are complications, or when the bladder has been damaged and needs repair. In open surgery, the surgeon makes an incision and removes the enlarged tissue from the prostate.
- Laser surgery. Laser surgery uses laser energy to destroy prostate tissue and shrink the prostate. Laser surgery may not be effective on larger prostates.
- Transurethral incision of the prostate (TUIP). This surgery does not involve removing prostate tissue. A few small cuts are made in the prostate gland to reduce the prostate's pressure on the urethra, making urination easier. This procedure is an option for some men, such as those with smaller prostates.
Points to Consider About Enlarged Prostate Treatments
Regarding Minimally Invasive Procedures:
- Both the TUMT and TUNA procedures provide greater symptom relief than medication, but are less effective than surgery for an enlarged prostate. Both have some urinary side effects that can last for several weeks.
- TUMT, TUNA, and ILC are equally effective in relieving BPH symptoms.
- In two studies of men with the UroLift system, researchers found a 30% increase in urine flow and participants reported a decrease in symptoms and an increase in quality of life in the two years following treatment.
- The decision to use minimally invasive therapies is based on the prostate's size, shape, and other factors.
Regarding Enlarged Prostate Surgery:
- With TURP, men may develop retrograde ejaculation (ejaculation of semen into the bladder instead of through the urethra). Sexual dysfunction is among the complications reported in 5% of patients, although that may not be related to surgery in all cases.
- With TUIP, there is significantly less risk of retrograde ejaculation, compared to TURP -- but TUIP produces symptom relief equal to TURP. However, some men require a repeat TUIP procedure. Doctors primarily base their decision whether to use TURP or TUIP on the prostate's size and shape.
- Laser procedures provide improvements in symptom relief, urinary flow, and quality of life similar to TURP. However, some laser therapies produce fewer side effects than others. Long-term studies are needed to determine whether laser treatments are as effective as TURP.
- Surgery can relieve many BPH symptoms, but it may not relieve all symptoms. If there are certain complications, such as a weak bladder, there may still be urinary problems after surgery -- although this is rare. With any BPH surgery, there may be a slight risk of erection problems. However, men who have normal erections before surgery will not likely have trouble achieving erections after surgery.
The best treatment for an enlarged prostate is not the same for every man. Talk to your doctor about the risks and benefits of each procedure. The one you choose will depend on the severity of your symptoms, how much risk you are willing to take, and other medical conditions you may have. Your doctor can help you decide what is best for you.