Do I Need Surgery for BPH?

Medications can help many men with an enlarged prostate, but for some, they might not always be enough to ease symptoms such as weak urine flow and dribbling.

When you’re one of those men, you have surgical options to treat your benign prostatic hyperplasia, or BPH.

5 Questions to Ask Before Surgery

As you think over the options for surgery, ask your doctor these questions:

  • Is there a good chance my condition will get better?
  • 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?

With newer technologies, doctors can do some procedures with tiny cuts (incisions) or use tube-style instruments that they insert into you. These can mean faster recoveries and less pain afterward.

Other times, the traditional “open” surgery is needed. It all depends on your case and what you and your doctor decide is best for you.

Doctors can choose from these minimally invasive procedures or open surgeries to treat moderate to severe symptoms. These procedures are also used if tests show that your ability to pee is seriously affected.

Minimally Invasive Procedures

There are minimally invasive procedures which utilize various energy sources to destroy excess prostate tissue causing urinary symptoms. These minimally invasive procedures are usually performed in the office. Overall, these procedures may work better than drugs at easing symptoms but may not be as effective as open surgery in some cases.

The following are some of the types you might talk about with your doctor:

Transurethral microwave therapy (TUMT). This procedure uses a microwave antenna attached to a flexible tube that your doctor inserts into your bladder. The microwave heat kills off excess prostate tissue.

Transurethral needle ablation (TUNA). Your doctor inserts a heated needle into the prostate through the urethra, the tube that carries urine and semen through the penis. The heated needle uses radiofrequency waves to heat up and destroy excess cells in the prostate gland.

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.

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Rezūm  water vapor therapy. A device is inserted into the urethra, your urine tube and a small needle delivers water vapor or steam to treat the excess prostate tissue.

TUMT and TUNA have some urinary side effects that can last for several weeks. All of these procedures are equally effective in easing your symptoms.

The decisions you and your doctor make to use a minimally invasive therapy are based on the size of the prostate, your other medical conditions and other details of your case.

Surgical Procedures

Doctors often consider surgery the best long-term solution for relief of bothersome urinary symptoms. Most of these involve taking out the enlarged part of the prostate.

Surgery is usually recommended in treating moderate to severe BPH-symptoms under these conditions:

  • You’re not able to pee at all.
  • Lifestyle changes, medicines, or minimally invasive treatments didn’t work for you.
  • You find blood in your urine that is not getting better.
  • You get bladder stones.
  • You get urinary tract infections a lot.
  • You have kidney damage.

Types of Surgery

The kinds of surgeries you might talk over with your doctor could include:

Transurethral resection of the prostate (TURP). Your doctor removes portions of the prostate that are affecting your urinary flow. This is the most common surgical procedure for BPH and remains the gold standard of interventional treatment options.

There is no cutting and no external scars are seen since a scope is inserted thorough the urethra to remove the excess tissue.

With TURP, some men might get what’s called “retrograde ejaculation,” (ejaculation of semen into the bladder instead of through the urethra). 

Transurethral incision of the prostate (TUIP). This surgery does not involve removing prostate tissue. A few small cuts are made in the prostate to reduce the gland's pressure on the urethra, making urination easier. This procedure is an option for some men, such as those with smaller prostates.

With TUIP, there is much less risk of retrograde ejaculation compared with TURP. However, it usually gives you symptom relief equal to TURP.

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One possible downside: Some men need a repeat TUIP. Doctors decide which to use based mainly on the prostate's size.

Laser surgery. A doctor uses laser energy to kill off prostate tissue and shrink the gland. This may not be as effective on larger prostates.

Laser procedures usually give you symptom relief and better urinary flow similar to TURP. However, some laser therapies produce fewer side effects than others.

Long-term studies are needed to find out whether laser treatments are as effective as TURP.

Open prostatectomy (open surgery). A doctor often does this 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 a cut and takes out the enlarged tissue from the prostate.

Laparoscopic and Robotic Prostatectomy. Laparoscopic or robotic surgery differs from traditional open surgery by making four small incisions as opposed to one large one to perform surgery to remove the enlarged tissue of the prostate.

Other Things to Consider

Before you have one of these procedures, talk with your doctor about whether you’ll be given something to numb the area (“local anesthesia”) or whether you’ll be given something so you won’t be awake (“general anesthesia”) during the procedure. What you get and where you have it depends on the procedure.

Your doctor will give you instructions on how to prepare for any of them.

Surgery can ease many BPH symptoms, but it may not relieve them all. 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 likely won’t have trouble afterward.

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.

WebMD Medical Reference Reviewed by Nazia Q Bandukwala, DO on April 10, 2018

Sources

SOURCES:

National Kidney and Urologic Diseases Information Clearinghouse.

American Urological Association. "Management of Benign Prostatic Hyperplasia (BPH)" 2014

Agency for Healthcare Policy Research.

William Jaffe, MD, professor of urology at Temple University School of Medicine, Philadelphia.

Urology Care Foundation, “What Are The Symptoms of BPH?”

Mayo Clinic, “Minimally invasive surgery.”

Medscape, “Male Uretha Anatomy: Overview,” “General anesthesia.”

National Health Service (U.K.), “Local anaesthesia: Introduction.”

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