Do I Need Surgery for BPH?

Medications can help most 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 minimally invasive procedures with tiny cuts (incisions) or use tube-style instruments that they insert into you. These procedures may not treat the symptoms to the same degree or durability as more invasive surgical options, they do have faster recoveries, less pain afterward and have reduced risks.

Other times, the traditional and more invasive surgery may be 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, endoscopic, 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

With newer technologies, doctors can use minimally invasive procedures with tiny cuts (incisions) or use tube-style instruments that they insert into the urethra. They relieve symptoms of BPH better than medicines. Other benefits include faster recovery and less pain than traditional, open surgery and fewer risks. These procedures do not involve removing or cutting into the prostate. Your doctor will consider the size of your prostate and your overall health to determine if minimally invasive surgery is right for you.

Types of minimally invasive surgery include:

  • 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. It is usually performed in your doctor’s office.
  • Transurethral microwave therapy (TUMT). This noninvasive 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.
  • UroLift system. The UroLift it is a permanently placed device used to lift and hold the enlarged prostate tissue out of the way, so it no longer blocks the urethra. There is minimal erectile and ejaculatory dysfunction. The procedure is typically performed using local or general anesthesia in a physician's office, ambulatory surgery center or operating room. Patients typically return home the same day without a catheter.
  • Transurethral needle ablation (TUNA). This procedure is no longer recommended for the treatment of BPH. It is an office-based procedure where 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.

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Invasive Surgery

More invasive surgery may be needed. You and your doctor will decide which is better for you. Doctors often consider invasive 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). This is the most common surgery to treat BPH. Your doctor removes portions of the prostate that are affecting your urine flow. 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. 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 and also reduce the risk of bleeding. 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.

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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 side effects or complications such as bleeding, narrowing of the urine tube also known as urethral stricture, urinary incontinence or leakage, erectile dysfunction, and retrograde ejaculation.

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 October 30, 2018

Sources

SOURCES:

National Kidney and Urologic Diseases Information Clearinghouse.

American Urological Association. "Management of Benign Prostatic Hyperplasia (BPH)" 2018

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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