Benign Prostatic Hyperplasia (BPH) is a common, non-cancerous condition involving the enlargement of the prostate gland. This enlargement can press on the urethra, leading to various urinary issues. When non-surgical treatments prove insufficient, several surgical options are available to relieve these symptoms. This article explores the different surgical approaches for BPH, offering insights into their mechanisms, effectiveness, and recovery processes.
Understanding BPH and When Surgery Becomes an Option
Benign Prostatic Hyperplasia (BPH) is common in aging men, affecting about half by age 50 and increasing with age. Its growth can compress the urethra, causing lower urinary tract symptoms (LUTS). These symptoms include frequent urination, especially at night, difficulty initiating a stream, a weak or interrupted flow, or incomplete bladder emptying.
While BPH is not cancerous and does not increase prostate cancer risk, its symptoms can significantly impact quality of life. Lifestyle changes or medications are initially recommended. However, surgery is considered when conservative treatments are ineffective, symptoms become severe, or complications arise. These complications can include recurrent urinary tract infections, bladder stones, kidney damage, or acute urinary retention.
Tissue Removal Procedures
Some surgical procedures for BPH involve removing or destroying prostate tissue to widen the urinary channel. Recovery expectations and potential side effects vary depending on the specific procedure performed.
Transurethral Resection of the Prostate (TURP)
Transurethral Resection of the Prostate (TURP) is a common surgical approach. During TURP, a surgeon inserts a resectoscope through the penis into the urethra to trim away excess prostate tissue blocking urine flow. Patients typically notice improved urinary symptoms within days, though full recovery can take four to six weeks. Common side effects include temporary burning or blood in the urine, urinary frequency or urgency, and retrograde ejaculation, where semen enters the bladder during orgasm.
Holmium Laser Enucleation of the Prostate (HoLEP)
Holmium Laser Enucleation of the Prostate (HoLEP) is a minimally invasive procedure using a holmium laser to precisely remove obstructing inner prostate tissue. This technique can remove a significant volume of prostate tissue, similar to open surgery, making it suitable for larger prostates. Patients typically experience quicker recovery, with a catheter often removed within 24 hours. Temporary urinary incontinence and retrograde ejaculation are common side effects, with blood in the urine potentially lasting up to three months.
Photoselective Vaporization of the Prostate (PVP)
Photoselective Vaporization of the Prostate (PVP), known as GreenLight Laser therapy, uses a high-powered green laser to heat and vaporize excess prostate tissue. This creates an open channel for urine flow, providing rapid symptom relief. PVP is often an outpatient procedure, with many patients going home within hours and the catheter usually removed within 24 hours. Potential side effects include blood in the urine, bladder irritation, and retrograde ejaculation.
Transurethral Incision of the Prostate (TUIP)
Transurethral Incision of the Prostate (TUIP) is a less invasive option, involving one to two small cuts in the prostate near the bladder neck. These incisions widen the urethra and reduce pressure, improving urine flow. TUIP is performed for mildly to moderately enlarged prostates and has a lower risk of retrograde ejaculation compared to TURP. Recovery usually takes three to five weeks, with temporary burning, bleeding, and urinary urgency.
Procedures That Reshape or Lift the Prostate
Newer, less invasive surgical options focus on reshaping or lifting prostate tissue without removing it. These procedures aim to improve urinary flow while often preserving sexual function and offering quicker recovery times.
Prostatic Urethral Lift (PUL)
The Prostatic Urethral Lift (PUL), known as UroLift, involves inserting tiny permanent implants through the urethra to hold enlarged prostate tissue away from the urinary channel. This lifts and retracts the prostate lobes, relieving compression on the urethra without cutting, heating, or removing tissue. UroLift is often an outpatient procedure, sometimes under local anesthesia, resulting in rapid symptom improvement with minimal or no catheterization. A key advantage of UroLift is its high rate of preserving sexual function, including antegrade ejaculation. Common temporary side effects include light blood in the urine, discomfort during urination, and mild pelvic discomfort, which generally resolve within two to four weeks.
Water Vapor Thermal Therapy (WVTT)
Water Vapor Thermal Therapy (WVTT), marketed as Rezum, uses sterile water vapor (steam) to treat enlarged prostate tissue. During the procedure, controlled bursts of steam are released into targeted tissue, causing cells to die and be absorbed by the body. This process shrinks the prostate and opens the urethra, improving urine flow.
Rezum therapy is typically performed in an office or outpatient setting, often without general anesthesia, and aims to preserve sexual function. Patients may begin to experience symptom relief within two weeks, with maximum benefits appearing around three months. A catheter may be needed for a few days post-procedure to aid urination during initial healing.
Prostate Artery Embolization (PAE)
Prostate Artery Embolization (PAE) is a minimally invasive procedure performed by an interventional radiologist, blocking small arteries supplying blood to the prostate. A catheter is inserted, usually through a small puncture in the groin, and guided to the prostatic arteries. Tiny particles are then injected to plug these arteries, reducing blood flow. This reduction in blood supply causes the prostate tissue to shrink over several months, alleviating urinary symptoms.
PAE is performed under local anesthesia and has a low risk of sexual side effects or incontinence. Recovery is generally faster than traditional surgeries, often requiring patients to avoid heavy lifting and sexual activity for about a week.
Recovery and Post-Operative Care
Following BPH surgery, a temporary urinary catheter is often placed to help drain urine while the prostate and urethra heal. The duration of catheter use varies by procedure, ranging from a few hours to several days. Patients are typically monitored in a recovery area immediately after surgery; many minimally invasive procedures allow for same-day discharge.
Pain is managed with medication, and patients may experience discomfort, burning during urination, or bladder spasms for several days to weeks. Blood in the urine is common, often appearing pink for one to three weeks, and can sometimes reappear intermittently as surgical sites heal. Drinking plenty of fluids is encouraged to help flush the bladder and reduce infection risk.
Activity restrictions are usually in place for a few weeks for proper healing. Doctors advise avoiding strenuous exercise, heavy lifting, and activities that put pressure on the pelvic area for about four to six weeks. Sexual activity is also typically restricted for a similar period. While many men can return to light work within one to three weeks, full recovery and complete symptom improvement may take several weeks to months as the bladder adjusts. Patients should follow all post-operative instructions and attend scheduled follow-up appointments.