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Surgical Procedures for Benign Prostatic Hyperplasia (BPH)

Related Media: Radical Prostatectomy

Most patients with urinary outflow obstruction begin treatment with medications. Surgical procedures are usually a second option when the condition is far advanced, urgent, or has not responded well to medications.

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 medication 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)

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Most Invasive Intervention

The most invasive surgery to treat BPH is prostatectomy. This involves the removal of the prostate gland.

References:

American Urological Association (AUA) Practice Guidelines Committee. AUA guideline on management of benign prostatic hyperplasia. Available at:
...(Click grey area to select URL)
Accessed September 8, 2017.
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 Plus website. Available at: http://www.dynamed.... Updated September 1, 2017. Accessed September 8, 2017.
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. Updated September 2014. Accessed September 8, 2017.
Last reviewed September 2017 by EBSCO Medical Review Board Adrienne Carmack, MD
Last Updated: 9/17/2014

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