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Surgery

Surgery

When medical therapy fails or when BPH symptoms are severe, surgery can be done to remove obstructing prostate tissue. Surgery is almost always recommended if you:

  • Are unable to urinate
  • Have kidney damage
  • Have frequent urinary tractd infections
  • Have a lot of bleeding
  • Have stones in the bladder

These types of surgery can be performed for BPH (please note these surgeries appear in order of least invasive to most invasive):

  • Transurethral Incision of the Prostate (TUIP)
  • Photoselective Vaporization of the Prostate (PVP)
  • Transurethral Resection of the Prostate (TURP)
  • Holmium Laser Enucleation of the Prostate (HoLEP)
  • Thulium Laser Enucleation of the Prostate (ThuLEP)
  • Transurethral Electrovaporization of the Prostate (TUVP)
  • Transurethral Water–Jet Ablation

Transurethral Incision of the Prostate (TUIP)

TUIP may be used if you have a smaller prostate but major blockage of the urethra. Instead of cutting and removing tissue, TUIP widens the urethra. The surgeon uses a laser beam or an electrical current to make small cuts in the bladder neck, where the urethra joins the bladder, and in the prostate. This reduces the pressure of the prostate on the urethra and makes urination easier. A catheter is left in your bladder for 1 to 3 days after surgery. The hospital stay is 1 to 3 days.

What are the Benefits, Risks, and Side Effects of TUIP

TUIP may improve the ability to urinate. It may ease symptoms. Temporary urine retention, urinary tract infection, dry orgasm, incontinence, and erectile dysfunction are possible side effects. Some men need additional treatment after TUIP.

Who are Good Candidates for TUIP?

Men who have a smaller prostate or do not want a more complete prostate resection but need surgery are good candidates for TUIP. The procedure is less likely to interfere with ejaculation than the more substantial TURP.

Photoselective Vaporization (PVP)

PVP is a very common surgery for BPH. In PVP, the surgeon guides a thin tube (a cystoscope) through the urethra to the prostate. Then the surgeon uses a laser to destroy obstructing prostate tissue and stop bleeding.

What are the Benefits, Risks, and Side Effects of PVP?

PVP is done as an outpatient procedure at the hospital or sometimes in the doctor’s office. Most men can have a PVP without adverse events. There is little bleeding and few side effects. After PVP, you can often stop medical therapy for BPH.

Who are Good Candiates for PVP?

Good candidates for PVP include men with small- to moderate-sized prostates and those with too many medical problems for more-invasive surgery. Men with weak hearts are also good candidates because there is no blood loss. So are men who want to limit anesthesia. Men with a higher risk of bleeding, such as those taking blood-thinning medications, may also be good candidates for PVP.

Transurethral Resection of the Prostate (TURP)

TURP is also a very common surgery for BPH. About 150,000 men in the United States have TURP each year.

After anesthesia, the surgeon inserts a thin, tube-like instrument (a resectoscope) through the tip of the penis into the urethra. The resectoscope has a light, valves for irrigating fluid, and a thin wire loop. An electrical current is passed along the wire. The surgeon uses the electrified wire to cut away prostate tissue that is blocking the urethra and seal blood vessels. The removed tissue is flushed into the bladder and from there out of the body. You will need to use a catheter for 1 to 2 days after the procedure.

What are the Benefits, Risks, and Side Effects of TURP?

This treatment has well known long-term outcomes. Other treatments are generally compared with it. Symptoms generally improve markedly. The effects of treatment last for 15 years or more.

TURP does not remove the entire prostate. No incisions (cuts) are needed. The hospital stay is 1 to 2 days or until there is no significant blood in your urine. TURP does require anesthesia. As with any surgery, anesthesia poses a risk.

Side effects of TURP may include retrograde ejaculation, erectile dysfunction, urinary tract infections right after surgery, and urinary incontinence. Full recovery takes about 4 to 6 weeks.

Who are Good Candidates for TURP?

Men who require surgery because of moderate to severe BPH symptoms may be good candidates for TURP.

Holmium Laser Enucleation of Prostate (HoLEP)

In HoLEP, the surgeon places a thin, tube-like instrument (a resectoscope) through the penis into the urethra. A laser inserted into the resectoscope destroys the excess prostate tissue.

What are the Benefits, Risks, and Side Effects of HoLEP?

No incisions (cuts) are needed. You will only need to stay 1 night in the hospital. There is very little bleeding. Recovery is rapid. You will need a catheter, but it is usually removed the next day. You may have blood in your urine or frequent or painful urination for a few days. This treatment requires anesthesia. Men having HoLEP have more post-operative stress urinary incontinence compared to the other surgeries, but this improves in about 1 year. As with any surgery, anesthesia poses a risk.

Who are Good Candidates for HoLEP?

Men with larger prostates who wish to avoid more-invasive surgery may be good candidates for this treatment. Men with a higher risk of bleeding, such as those taking blood-thinning medications, may also be good candidates for HoLEP.

Thulium Laser Enucleation of the Prostate (ThuLEP)

ThuLEP is similar to HoLEP but uses a different type of laser. As in HoLEP, the surgeon places a thin, tube-like instrument (a resectoscope) through the penis into the urethra. A laser inserted into the resectoscope destroys the excess prostate tissue.

What are the Benefits, Risks, and Side Effects of ThuLEP?

No incisions (cuts) are needed. There is very little bleeding. Recovery is rapid. You will need a catheter, but it is usually removed the next day. You may have blood in your urine or frequent or painful urination for a few days. You will only stay 1 night in the hospital. But this treatment requires anesthesia. As with any surgery, anesthesia poses a risk.

Who are Good Candidates for ThuLEP?

Men with larger prostates who wish to avoid more-invasive surgery may be good candidates for this treatment. Men with a higher risk of bleeding, such as those taking blood-thinning medications, may also be good candidates for ThuLEP.

Transurethral Electroevaporation of the Prostate (TUVP)

In TUVP, the surgeon inserts a thin, tube-like instrument (a resectoscope) into the urethra. This instrument has a lens, a light, and a tool that sends out an electrical current to destroy prostate tissue. Heat from the electrical current seals small blood vessels, reducing the risk of bleeding.

What are the Benefits, Risks, and Side Effects of TUVP?

There is little bleeding or fluid absorption. You stay 1 night in the hospital and you can usually return home without a catheter. This treatment requires anesthesia. As with any surgery, anesthesia poses risks.

Who are Good Candidates for TUVP?

Men with larger prostates who wish to avoid more-invasive surgery may be good candidates for TUVP.

Transurethral Water–Jet Ablation (TWJA)

TWJA (also known as Aquablation® therapy) is a new treatment for BPH. It uses high-pressure water jets to destroy excess prostate tissue. The surgeon first uses ultrasound to precisely map the location of the excess tissue. Then the high-pressure water jets are directed to that area through a special handpiece that is inserted into the bladder. Following this, the surgeon inserts another instrument to seal small blood vessels to reduce the risk of bleeding. The patient needs to stay in the hospital overnight to irrigate the bladder to prevent blood clots.

What are the Benefits, Risks, and Side Effects of TWJA?

TWJA requires general anesthesia. As with any surgery, anesthesia poses a risk. The procedure takes at least an hour. You will need to use a catheter for about 48 hours after the procedure. You should be able to go home the next day. Men may have fewer sexual side effects after TWJA than a TURP. How it compares to the minimally invasive therapies, which do not impact sexual function, is not known. Because this is a new type of therapy follow-up has not been very long (1 year only). It is not currently known whether the treatment continues to work long-term or whether patients eventually need to have additional treatment.

Who are Good Candidates for TWJA?

Because this is such a new therapy, it is not clear who are the best candidates for this treatment.

Related Resources

BPH in Men Video

Urology 101 Video


BPH Podcast Episode

Listen to more podcasts


Prostate Health Playbook

Prostate Health Playbook


Infographic

Infographic


CareBlog Articles

Prostate Health 101

How To Keep Your Prostate Happy


 

Other Groups' Resources

National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)

Prostate Enlargement: Benign Prostatic Hyperplasia


MedlinePlus

Enlarged Prostate (BPH) (English)
Agrandamiento de la próstata (Español)

 

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