Surgery may be recommended to treat benign prostatic hyperplasia, or BPH, when medications and minimally invasive procedures are ineffective, or when symptoms are particularly bothersome or severe. Men who have these surgical procedures require local, regional, or general anesthesia and may need to stay in the hospital. Surgical procedures to remove enlarged prostate tissue include:
Transurethral Resection of the Prostate (TURP)
This is the most common surgery for BPH and is considered the gold standard for treating blockage of the urethra due to BPH. During this procedure, the provider passes an instrument called a resectoscope through the urethra to the prostate. Pieces of enlarged prostate tissue are cut and removed using a wire loop at the end of the resectoscope. Special fluid carries the tissue pieces into the bladder, and the pieces are flushed out at the end of the procedure.
In this procedure, side-firing laser fibers are used to vaporize prostate tissue that obstructs the flow of urine. The provider uses a cystoscope to pass the laser fiber through the urethra into the prostate and then delivers several bursts of energy. The laser energy destroys prostate tissue and causes shrinkage. It also seals blood vessels as it cuts through the prostate tissue, which reduces the risk of bleeding and often allows for a quicker recovery time.
Transurethral Incision of the Prostate (TUIP)
This procedure is used to widen the urethra. The provider inserts a cystoscope and an instrument that uses an electric current or a laser beam through the urethra to the prostate. Several small incisions are made in the bladder neck, where the urethra joins the bladder, and in the prostate gland itself, which relieves pressure without trimming away tissue.
In an open prostatectomy, all or part of the prostate is removed through an incision in the lower abdomen or between the anus and scrotum. This procedure is done only in rare cases, when the prostate is very large with severe obstruction, or when other procedures cannot be performed. General or spinal anesthesia is used, and a catheter remains in place for up to seven days after the surgery. Open prostatectomy has a higher risk of complications, such as incontinence and impotence, than other medical treatments or less invasive procedures.