Benign (Non-Cancerous) Prostate Surgery

Overview

Why would you have surgery for a benign (non-cancerous) prostate condition?

The prostate is the walnut-sized gland that surrounds the urethra in a male. The urethra is the tube that carries urine from the bladder to outside the body. One of the non-cancerous conditions that can affect the prostate is called benign prostatic hyperplasia (BPH), which is also known as enlarged prostate.

BPH is the most common prostate problem in men over age 50. About half of men in their 50s and as many as 90% of men in their 70s and 80s have enlarged prostates.

Enlarged prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:

  • An inability to urinate.
  • Frequent urinary tract infections.
  • Excessive blood in the urine.
  • Bladder stones.
  • Kidney damage.

Prostate cancer and infertility aren’t symptoms or causes of BPH. Benign prostatic hyperplasia doesn’t cause erectile problems.

Prostate procedures for BPH range from minimally invasive treatments to more extensive surgeries. Your healthcare provider will help you decide which type of prostate surgery is best for you.

Procedure Details

What are the types of prostate surgery for benign prostatic hyperplasia (BPH)?

Several minimally invasive surgeries may be used for benign prostatic hyperplasia. These include:

GreenLight™ laser: Photoselective vaporization of the prostate (PVP) is a treatment that vaporizes prostate tissue to create a channel in the urethra for free urination. This is surgical treatment performed in the operating room under general anesthesia.

Plasma button electrovaporization: Prostate tissue is removed using low temperature plasma energy. Tissue is vaporized. This is an operating room-based therapy and requires an anesthetic.

Water vapor therapy (Rezum™): Water vapor is directly delivered to the prostate tissue. Over a 3-month period the tissue is destroyed and reabsorbed by the body. This is an office-based therapy and is performed under a local nerve block.

UroLift®: A mechanical approach that places implants to pin the lateral prostate lobes out of the way to reduce obstruction. This is an office-based procedure performed under a local nerve block.

Prostatic artery embolization: This approach uses catheters to deliver agents that block blood flow to the prostatic artery to reduce symptoms of BPH by shrinking tissue. This prostate procedure uses local anesthesia and doesn’t require a hospital stay.

What are other benign prostatic hyperplasia (BPH) surgery options?

If your symptoms are severe or minimally invasive surgical treatments don’t help with your enlarged prostate, your doctor will likely recommend another kind of surgery. Other prostate procedures include:

Transurethral resection of the prostate (TURP): This is the most common treatment for BPH. During this procedure, your urologist will insert a rigid instrument called a resectoscope into the urethra. This is why it is called transurethral. Inserting the scope this way means no cutting into the prostate. They will then use the charged resectoscope to remove the excess tissue that is blocking the urine from leaving the bladder.

You may be put to sleep with general anesthesia. Local anesthesia for the lower part of the body may be used for this procedure. The average in hospital stay for TURP is 1 to 2 days.

Transurethral incision of the prostate (TUIP): This is a similar procedure to TURP. Instead of prostate tissue being removed the bladder neck and prostate are cut to relax the bladder opening, allowing urine to flow more freely. TUIP is most successful on men with smaller prostates.

Simple prostatectomy: This method is a surgical procedure in which an incision is made through the abdomen or performed laporoscopically. The inner portion of the prostate gland is removed, leaving the outer segment intact.

Risks / Benefits

What are the risks of benign prostatic hyperplasia (BPH) surgery?

Surgery for benign prostatic hyperplasia is common and generally very safe. However, there are risks with any surgery, such as those related to anesthesia. Risks after procedures can include those related to urine:

  • Urinary tract infections.
  • Frequent urination.
  • Blood in the urine.
  • An inability to hold urine (incontinence).
  • Painful urination or difficulty urinating.

Other risks include:

Recovery and Outlook

What is the outlook for men who have benign prostatic hyperplasia (BPH) surgery?

Benign prostatic hyperplasia surgery has a very high success rate. However, for the best results from treatment, you should seek medical help at the earliest signs of a problem. Also, talk with a doctor if you are experiencing symptoms of BPH after surgery.

There is no evidence that BPH increases the risk of developing prostate cancer. However, the symptoms of BPH and prostate cancer are similar. The American Urological Association and the American Cancer Society recommend annual prostate screenings for men ages 55 to 69. Men at high risk – such as African-American men and men with a family history of prostate cancer – should begin screening at age 40.

Last reviewed by a Cleveland Clinic medical professional on 12/08/2020.

References

  • American Urological Association. Benign Prostatic Hyperplasia: Surgery. (http://www.urologyhealth.org/urologic-conditions/benign-prostatic-hyperplasia-%28bph%29/treatment/surgery) Accessed 12/30/2020.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Prostate Enlargement (Benign Prostatic Hyperplasia). Accessed 12/30/2020.
  • American Academy of Family Physicians. Benign Prostatic Hyperplasia. (https://familydoctor.org/condition/benign-prostatic-hyperplasia-bph/) Accessed 12/30/2020.
  • Harriman D, Mayson BE, Leone EF. A rare but serious complication of GreenLight HPS photoselective vaporization of the prostate: Prostatic capsular perforation with bilateral thigh urinomas and osteitis pubis. Can Urol Assoc J. 2013;7(1-2):E105-E107. doi:10.5489/cuaj.230
  • Cindolo L, Ruggera L, Destafanis P, Dadone C, Ferrari G. Vaporize, anatomically vaporize or enucleate the prostate? The flexible use of the GreenLight laser. Int Urol Nephrol. 2017;49(3):405-411.
  • Sun, I., Yoo, S., Park, J. et al. Quality of life after photo-selective vaporization and holmium-laser enucleation of the prostate: 5-year outcomes. (https://doi.org/10.1038/s41598-019-44686-2) Sci Rep 9, 8261 (2019). Accessed 12/30/2020.
  • Abt D, Hechelhammer L, Mullhaupt G, et al. Comparison of prostatic artery embolization (Pae) versus transurethral resection of the prostate (Turp) for benign prostatic hyperplasia: randomized, open label, non-inferiority trial. BMJ. Published online June 19, 2018:k2338.

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