Urology

Urological Conditions

Benign Prostatic Hyperplasis (BPH)

Surgical Treatments

Surgical treatments are normally reserved for the most severe cases of BPH. In the past, surgery for BPH was extremely common and even today it remains one of the most common surgeries for men over sixty. Surgery may also be the most effective treatment. But because it has the highest risk of side effects and newer, less invasive treatments are now available, it is most often recommended for men with symptoms such as:

The three main types of surgery for BPH are:

TURP (transurethral resection of the prostate). This is the most common surgical treatment for BPH. It uses a resectoscope (a tiny metal instrument inserted through the penis into the urethra) to remove the excess tissue and seal blood vessels. An irrigating fluid carries the removed tissue into the bladder. The tissue is then flushed out and sent to a pathologist for examination under a microscope. The entire procedure takes about 90 minutes. You’ll be given general anesthesia, will remain in the hospital one to three days, and may need to wear a catheter for a few days after you leave the hospital. Common side effects include blood in the urine, discomfort while urinating, urinary urgency, or incontinence (difficulty controlling urination) and sexual dysfunction. These symptoms usually improve or disappear during recovery (though in some cases this can take up to a year).

Retrograde ejaculation (dry climax) is the most common, long-term side effect of prostate surgery. During ejaculation, semen flows back into the bladder instead of out through the penis. This will not affect a man’s ability to experience sexual pleasure but can cause sterility (inability to have children). For most men who need prostate surgery, this is not an issue.

TUIP (transurethral incision of the prostate). This is often used when the prostate is not greatly enlarged. Instead of actually removing prostate tissue, the surgeon uses the resectoscope to make one or more cuts in the bladder neck where the urethra joins the bladder, and in the prostate itself. This widens the urethra making it easier to urinate.

Open Prostatectomy. This is the removal of the prostate. Because it has the greatest risk of side effects, it’s used only when the patient’s condition makes a transurethral procedure (TURP or TUIP) inadvisable. (For example, patients with very large prostates, bladder stones, bladder damage, or urethral strictures would be candidates for open prostatectomy.) The procedure is called “open prostatectomy” because the prostate is removed through an incision in either the lower abdomen or in the perineum (area between the rectum and the scrotum). If you have this type of surgery, you will be given general or regional anesthesia, stay in the hospital for several (3-5) days and go home with a urinary catheter. You will need to avoid sexual intercourse for 6 weeks after surgery, and heavy lifting and other strenuous exercise for about 8 weeks. Possible side effects include blood in the urine, incontinence and erectile dysfunction (impotence).

Note that the complete removal of the prostate (a “radical prostatectomy”) is one of the possible treatments for prostate cancer. Normally, for the treatment of BPH, only the inner portion of the prostate is removed. The outer portion remains intact.