Several surgical approaches are used to treat BPH. Reasons for performing prostate surgery include:
- Persistent or recurrent episodes of urinary retention (inability to urinate)
- Persistent blood in the urine
- Bladder stones
- Patients with moderate or severe lower urinary tract symptoms that are not responding to medications
Invasive Procedures. The most effective surgical procedure, transurethral resection of the prostate (TURP) is also the most invasive. It has the highest risk for serious complications, including blood loss, erectile dysfunction, and urinary incontinence. However, because it is more effective than less invasive procedures, TURP remains the procedure of choice for many doctors. When considering invasive surgery, the patient should be sure that the surgeon is experienced in performing these procedures.
Less Invasive Procedures. Minimally invasive procedures use some form of heat to destroy excess prostate tissue. The heat may be delivered by:
- Radio frequency: Transurethral needle ablation (TUNA)
- Microwave: Transurethral microwave thermotherapy (TUMT)
- Electrical current: Transurethral electrovaporization (TUVP)
- Hot water: Water-induced thermotherapy (WIT)
- Laser: Interstitial laser coagulation (ILC) , holmium laser enucleation of the prostate (HoLEP), and photoselective vaporization (PVP)
Although minimally invasive procedures may be an appropriate choice for some patients depending on the circumstances, none of them to date have proven superior to TURP. Over 5 - 10 years of follow-up, a higher percentage of patients receiving these less invasive procedures need surgery again. Minimally invasive procedures may be appropriate for certain patients, such as:
Review Date: 07/20/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.