Surgical Procedures for Benign Prostatic Hyperplasia (BPH)
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Most patients with urinary outflow obstruction begin treatment with medicines. Surgical procedures are usually a second option when the condition is far advanced, urgent, or has not responded well to medicine.

Emergency Treatment
If the bladder is completely obstructed and you are unable to pass any urine at all, you must be treated immediately. A tube will be placed into the bladder to drain out the urine. The tube may be left in place until the passageway can be more permanently opened. The bladder can be drained with either of these procedures:

  • Transurethral catheterization—involves a rubber catheter being slipped past the obstruction to allow urine to drain out.
  • Suprapubic catheterization—may be done if transurethral catheterization fails. A catheter is inserted through the lower abdomen to drain the bladder. A tube can be installed and left in until the obstruction is cleared.
Surgery
Minimally Invasive Interventions
In non-emergency situations when medicine has not been effective, there are many new procedures available to open the channel through the prostate. These procedures are typically done on an outpatient basis. You will have some type of anesthesia, typically a combination of local anesthesia and oral sedation. The procedure may involve threading an instrument into your penis. Depending on the particular device, you will probably feel nothing more than that. Each procedure takes about an hour. There are significant differences between these minimally invasive treatments. Talk to your doctor before choosing this as a treatment option.

Examples of minimally invasive procedures include:

  • Stents and tubes—This involves the insertion of a variety of temporary and permanent stents and tubes devised to hold open the urethra. These are most useful in patients who are too ill or weak to tolerate more extensive procedures. This treatment is used rarely in the United States at the present time.
  • These procedures use some form of heat to destroy prostate tissue:
    • Transurethral microwave thermotherapy (TUMT)—uses microwaves emanating from a catheter placed into your bladder to destroy excess prostate tissue
    • Transurethral needle ablation (TUNA)—uses low levels of radiofrequency energy to burn away portions of the enlarged prostate
More Invasive Interventions
All of these interventions require some type of anesthesia, either regional or general. The procedure involves placing surgical tools through your urethra (the tube in your penis).

Examples of these more invasive procedures include:

  • Holmium laser enucleation of the prostate (HoLep)—prostate tissue is removed using a laser fiber
  • Photoselective vaporization of the prostate (PVP)—a high-powered laser is used to vaporize prostate tissue, achieving a similar result to transurethral resection of the prostate (TURP)
  • Transurethral resection of the prostate (TURP)—traditional standard treatment of BPH; a scope with a heated wire is inserted through the penis
  • Transurethral incision of the prostate (TUIP)—small cuts are made in the bladder neck to widen the urethra; done in younger patients with smaller prostates
  • Transurethral laser therapy or interstitial laser coagulation (ILC)—uses highly focused laser energy to remove prostate tissue
Transurethral resection of the prostate (TURP)

Copyright © Nucleus Medical Media, Inc.
Most Invasive Intervention
The most invasive surgery to treat BPH is prostatectomy . This involves the removal of the prostate gland.




References:
Armitage JN, Rahidian A, et al. Thermo-expandable metallic stent for managing benign prostatic hyperplasia: a systematic review. BJU Int. 2006;98:806-810.

Bouza C, Lopez T, et al. Systematic review and meta-analysis of transurethral needle ablation in symptomatic benign prostatic hyperplasia. BMC Urol. 2006;6:12-23.

BPH. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated August 27, 2012. Accessed September 14, 2012.

BPH. National Kidney Urologic Diseases Information Clearinghouse website. Available at: http://kidney.niddk.nih.gov/kudiseases/pubs/prostateenlargement/#treatment. Updated March 23, 2012. Accessed September 14, 2012.

Fried MM. New laser treatment approaches for benign prostatic hyperplasia. Curr Urol Rep. 2007;8:47-52.

Herrmann TR, Gross AJ, et al. Transurethral microwave thermotherapy for the treatment of BPH: still a challenger? World J Urol. 2006;24:389-396.

Medical Management of BPH. American Urological Association Foundation website. Available at: http://www.urologyhealth.org/adult/index.cfm?cat=09&topic=101. Updated January 2011. Accessed September 14, 2012.

Last Reviewed September 2014



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