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.
Benign prostatic hyperplasia (BPH) surgery refers to a variety of surgical procedures used to treat a condition called benign prostatic hyperplasia.
BPH, also known as an enlarged prostate, is a benign, or non-cancerous, condition that affects many men as they age. It 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.
In BPH, the enlarged prostate squeezes or blocks the urethra. When men enter their 40s, the prostate begins to grow. If the prostate becomes too enlarged, it can cause problems with urination.
Early symptoms of BPH are:
If left untreated, BPH can block the urethra further and lead to more serious symptoms, including:
Prostate cancer and infertility are not symptoms or causes of BPH. Benign prostatic hyperplasia does not cause erectile problems.
If you experience any symptoms of benign prostatic hyperplasia, you should seek medical help. Your doctor will begin an exam by asking about your symptoms. He or she will do a urinalysis and rectal exam to manually examine the prostate. A test called PSA (prostate-specific antigen) will also be done to rule out prostate cancer.
If your doctor finds that you have benign prostatic hyperplasia, you will be given a variety of treatment options. Treatment usually begins with the least invasive options that do not involve surgery.
The first treatment for BPH is often making lifestyle changes. You may be advised to avoid alcohol and caffeine, drink less liquid, and do exercises to strengthen your pelvic muscles.
The next level of treatment for benign prostatic hyperplasia is usually medications such as tamsulosin (Flomax®). This is a type of drug called an alpha blocker. It is meant to relax the bladder neck muscles and prostate muscles to increase urinary flow and decrease the urge to urinate.
Other drugs called alpha reductase inhibitors, such as finasteride (Propecia®, Proscar®) and dutasteride (Avodart®), can be used to reduce the size of the prostate and reduce urine flow.
If lifestyle changes and medications do not help with BPH, surgery is the next option. Surgical options range from minimally invasive therapies to full surgery.
Benign prostate surgery is recommended if less invasive treatments have failed, or if you have severe symptoms such as:
Several minimally invasive surgeries may be used for BPH. 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 an office-based therapy and requires an anesthetic.
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.
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 tissue 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 tissue block.
If your symptoms are severe or minimally invasive surgical treatments do not help with your enlarged prostate, your doctor will likely recommend another kind of surgery. Several surgical options 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 tube this way means no cutting into the prostate. He or she will then use the charged resectoscope to remove the excess tissue that is blocking the urine from exiting 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: 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.
Surgery for benign prostatic hyperplasia is common and generally very safe. However, there are risks with any surgery. Risks after procedures can include:
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.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 08/01/2017