BPH > Treatment
Surgery
There are a number of surgical options for BPH:
Transurethral resection of the prostate (TURP) is the most usual operation for men who have not responded to medical therapy or who have developed complications such as complete retention of urine, and is usually carried out under a general anaesthetic. It involves passing an instrument up through the penis, and then using it to cut the middle out of the enlarged prostate, piecemeal. A catheter will be passed through the urethra into the bladder at the end of the operation to drain off the urine. This will be left in place for a couple of days. A normal hospital stay following TURP is 3 or 4 days, but you should try to rest as much as possible for a few weeks afterwards to minimize the risk of secondary complications such as bleeding that may occur 10-12 days after the original operation.
| During a TURP, the middle of the prostate is removed using an instrument passed through the urethra. |
After the operation, you may find that you experience an urgent need to urinate and/or a burning sensation when you pass urine. This should disappear within a few weeks. You may also notice some blood in your urine. This is normal, but if it is particularly heavy or persists for more than a few weeks, or if you notice some blood clots, drink extra fluids and contact your doctor.
The most common side effect is a phenomenon known as retrograde ejaculation - where semen passes into the bladder during orgasm, rather than out through the penis. You then pass the semen mixed with urine the next time you urinate. This is not harmful and, providing that they know about this potential side effect before undergoing the surgery, most men do not find it bothersome. However, retrograde ejaculation may reduce your fertility, though it does not make you reliably sterile.
| Retrograde ejaculation is a common side effect of a TURP. Semen passes into the bladder rather than out through the urethra and penis at orgasm. |
A few men complain of an inability to achieve or maintain an erection after the operation, though this does not seem to be a problem specifically caused by this surgical procedure. In a study that compared men with BPH who had undergone a TURP with men with BPH who had not had surgery, the proportions of men who reported erectile problems were similar. Some were even improved by surgery.
Some men notice some incontinence after a TURP - if you find that you are leaking urine slightly, talk to your doctor. This problem nearly always resolves completely with time, but if it persists further investigation may be warranted.
An operation under general anaesthetic always carries some small risks, as occasionally an individual reacts badly to anaesthesia. There is also a small chance of significant blood loss and the subsequent need for a transfusion. In the postoperative period, there may be problems with catheter blockage or bleeding after the catheter has been removed. These problems are relatively unusual with a TURP, however, and the outcome is usually good.
When a TURP is performed the prostate tissue removed is sent to the pathology laboratory for analysis. In most cases the results come back confirming benign prostatic hyperplasia (BPH); however, in around one case in ten, a small amount of prostate cancer is identified. Small areas of prostate cancer may not require active treatment, but careful follow-up is indicated and biopsy of the remaining prostate tissue should be considered, as it may harbour some residual cancer tissue.
Transurethral incision of the prostate (TUIP) is appropriate for the man who is experiencing obstruction problems but who has a relatively small prostate. It is quite quick to perform, taking only around 20 minutes, but you will still be given a general or spinal anaesthetic. As with a TURP, an instrument will be passed up through the penis, but with a TUIP, rather than removing a portion of the prostate, one or two small cuts are made in the neck of the bladder and in the prostate. These have the effect of reducing the obstruction and allowing the bladder neck to spring apart. As with a TURP, you will be catheterised at the end of the operation to allow urine to drain away freely. The catheter will be removed after around 24-48 hours, and you will be able to leave hospital after a couple of days. For the next week or so, you should take things easy.
| In TUIP, several small cuts are made in the bladder neck and prostate. This relieves the pressure on the urethra and urine can flow more easily. |
The chance that you will experience a side effect following a TUIP is lower than following a TURP. Retrograde ejaculation (see above), for example, affects a much lower proportion of men after the operation (one in ten compared with eight in ten).
There is a risk that symptoms will return after the operation (see table below); if this happens, then it is likely that you will need a TURP.
Again, as the operation is performed using a general anaesthetic, there is a small risk of anaesthetic-related complications and postoperative bleeding.
Open prostatectomy is only really appropriate for the man whose prostate is very large (more than 100 grams) or who has large bladder stones. It is a more complex procedure than a TURP, and complications afterwards are somewhat more likely.
The surgeon gains access to the prostate through a horizontal incision made in the lower abdomen. Through a cut made either in the prostate or bladder, the surgeon is then able to remove the central part of the prostate. A catheter will be inserted into your bladder during the operation so that urine can drain away, and this will be left in place for 3 or 4 days. Because this is relatively major surgery, you will usually need to stay in hospital for about a week. Even when you go home, you are advised to rest for up to 6 weeks, and you should avoid lifting anything heavy for several months. The operation will leave a scar.
| In an open prostatectomy, the central part of the prostate is removed through an incision in the abdomen and a catheter is inserted to drain urine from the bladder. |
An open prostatectomy can also result in retrograde ejaculation (see above), with about seven in ten men being affected; some men also find it difficult to achieve/maintain an erection (around two men in ten). The risks associated with surgery of this type are discussed in the TURP section.
The long-term picture following surgery: Useful information comparing the outcomes following each surgical procedure is presented in the table below.
| Outcome after the three main surgical options for treatment of BPH | |||
| TURP | TUIP | Open prostatectomy | |
| Likelihood that symptoms will improve | 90% | 80% | 98% |
| Usual reduction in symptom score (see reference) | 85% | 73% | 79% |
| Likelihood that you will need further surgery within 8 years | 16%–20% | Over 20% | 10% |