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Surgical Procedures for Benign Prostatic Hyperplasia (BPH)

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Surgery may be needed if BPH is far advanced or not responding to medicine. It may also be needed if there is an urgent need.

Emergency Treatment

Urine that is completely blocked is an emergency. Treatment will be needed immediately. A tube will be placed into the bladder to allow the urine to drain. The tube may be left in place until the path can be better opened. The catheter will be placed as:

  • Transurethral catheterization—a rubber catheter is slipped past the obstruction to the bladder.
  • Suprapubic catheterization—may be needed if transurethral does not work. A tube is passed through the lower belly. A tube can be installed and left in until the blockage is cleared.

Surgery

Minimally Invasive Interventions

Most procedures will use a tool that is inserted into the penis. It can then pass up to the blockage. There are different methods to remove excess tissue or open the path for urine. Procedures often take about an hour. Medicine will help to numb the area during procedure. The type of surgery will depend on specific needs. Examples of minimally invasive procedures include:

  • Excess prostate tissue may be removed with one of the following:
    • Transurethral microwave thermotherapy (TUMT)—uses a type of heat to destroy excess prostate tissue
    • Transurethral needle ablation (TUNA)—uses low levels of radiofrequency energy to burn away excess prostate tissue
  • Stents and tubes—a stent or tube is placed at the narrowed area. It will help to hold open the urethra. The stent may be temporary or permanent. It may be chosen for patients who are too ill or weak to tolerate more intense surgery.

More Invasive Interventions

These interventions will use either regional or general anesthesia. A tool is passed through the tube in your penis to the blocked area. Work can then be done to improve the path for urine flow. Choices for treatment include:

  • Holmium laser enucleation of the prostate (HoLep)—a laser fiber destroys excess tissue.
  • Photoselective vaporization of the prostate (PVP)—a high-powered laser destroys prostate tissue.
  • Transurethral resection of the prostate (TURP)—traditional standard treatment of BPH. A heated wire is used to remove excess tissue.
  • Transurethral incision of the prostate (TUIP)—small cuts are made in the bladder neck. It will widen the urethra. This may be the choice in younger patients with smaller prostate.
  • Transurethral laser therapy or interstitial laser coagulation (ILC)—a highly focused laser is used to remove excess prostate tissue.
Transurethral resection of the prostate (TURP)
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Most Invasive Intervention

Prostatectomy is the removal of the prostate gland. It is the most invasive surgery to treat BPH.

REFERENCES:

American Urological Association (AUA) Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia. Available at: http://www.auanet.org/guidelines/benign-prostatic-hyperplasia-(2010-reviewed-and-validity-confirmed-2014). Accessed September 21, 2020.

Armitage JN, Rahidian A, Cathcart PJ, Emberton M, van der Meulen JH. Thermo-expandable metallic stent for managing benign prostatic hyperplasia: a systematic review. BJU Int. 2006;98(4):806-810.

Bouza C, Lopez T, Magro A, Navalpotro L, Amate JM. Systematic review and meta-analysis of transurethral needle ablation in symptomatic benign prostatic hyperplasia. BMC Urol. 2006;6:14.

Benign prostatic hyperplasia (BPH). EBSCO DynaMed website. Available at:https://www.dynamed.com/condition/benign-prostatic-hyperplasia-bph. Accessed September 21, 2020.

Fried MM. New laser treatment approaches for benign prostatic hyperplasia. Curr Urol Rep. 2007;8(1):47-52.

Herrmann TR, Gross AJ, Schultheiss D, Kaufmann PM, Jonas U, Burchardt M. Transurethral microwave thermotherapy for the treatment of BPH: still a challenger? World J Urol. 2006;24(4):389-396.

Prostate enlargement: benign prostatic hyperplasia. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/health-topics/urologic-disease/benign-prostatic-hyperplasia-bph/Pages/facts.aspx. Accessed September 21, 2020.

Last reviewed September 2020 by EBSCO Medical Review Board Adrienne Carmack, MD  Last Updated: 11/4/2020