Benign Prostatic Hyperplasia (BPH), commonly known as an enlarged prostate, is a non-cancerous condition that affects many men as they age. The prostate gland, which surrounds the urethra, grows larger, leading to bothersome urinary symptoms. These symptoms can include frequent urination, a weak urine stream, difficulty starting urination, and the feeling of incomplete bladder emptying. When lifestyle changes and medications are no longer effective, surgical intervention becomes a viable option to improve urinary flow and quality of life.
Minimally Invasive Approaches to BPH
Minimally invasive surgical treatments for BPH offer less downtime and often preserve sexual function. These procedures are performed in an outpatient setting, allowing for a quicker return to daily activities compared to more traditional surgeries. The less invasive nature makes them suitable for men with smaller to moderate prostate sizes and those who prioritize maintaining sexual health.
Rezūm water vapor therapy
Rezūm water vapor therapy utilizes steam to shrink excess prostate tissue. During the procedure, which takes minutes, steam is released into the targeted prostate tissue. The steam causes the cells to die. Over time, the body naturally absorbs the treated tissue, leading to prostate shrinkage and an opening of the urethra. Patients experience mild discomfort and may use a catheter for 1 to 3 days, with symptom improvement seen within two weeks and full benefits within three months.
The UroLift System
The UroLift System employs small, permanent implants to hold open the enlarged prostate tissue. This procedure lifts and holds the obstructing prostate lobes apart without cutting, heating, or removing tissue. The UroLift procedure takes less than an hour and can be performed under local or general anesthesia in an outpatient setting. Patients go home the same day without a catheter and experience rapid symptom relief, with improvement within two weeks. Side effects are mild and temporary, resolving within two to four weeks.
Traditional Surgical Solutions for BPH
For men with larger prostates, more severe symptoms, or when minimally invasive options are not suitable, traditional surgical solutions offer effective relief. These procedures are more involved, requiring a longer recovery period and an inpatient hospital stay. They aim to remove significant amounts of prostate tissue to alleviate obstruction.
Transurethral Resection of the Prostate (TURP)
Transurethral Resection of the Prostate (TURP) involves inserting a resectoscope through the tip of the penis and into the urethra. An electrical loop on the resectoscope is then used to trim away excess prostate tissue. This procedure is effective in quickly relieving symptoms and improving urinary flow. Patients remain in the hospital for one to two days after TURP and may need a catheter for a few days. Full recovery can take four to six weeks, during which strenuous activities should be avoided.
Open Prostatectomy
Open Prostatectomy involves surgically removing prostate tissue through an incision, made in the lower abdomen. This approach is reserved for men with very large prostates. While it is a more invasive procedure, it is highly effective in improving symptoms and reducing the likelihood of needing future BPH surgeries. The recovery period for an open prostatectomy is longer than for TURP, requiring a hospital stay of several days, with a catheter remaining in place for about three to ten days. Patients can return to most normal activities around four to eight weeks after surgery.
Navigating Your BPH Surgery Journey
Preparing for BPH surgery involves several steps. Before surgery, patients undergo pre-operative assessments, which may include blood tests and a physical examination. Urine and prostate-specific antigen (PSA) blood tests may also be conducted to assess prostate health. Patients may receive instructions regarding medication adjustments and may be prescribed antibiotics to prevent infection.
On the day of surgery
On the day of surgery, patients will receive anesthesia, which could be general (where the patient is asleep) or spinal (where the patient is numb from the waist down). The choice of anesthesia depends on the type of procedure and the patient’s overall health. The duration of the procedure varies, with minimally invasive options taking less than an hour, while more traditional surgeries can take longer. Most minimally invasive procedures are performed in an outpatient setting, whereas traditional surgeries may require an inpatient hospital stay.
Immediately after surgery
Immediately after surgery, patients are moved to a recovery area where their vital signs are monitored. Many patients will have a urinary catheter in place to drain urine, as swelling in the prostate area can temporarily block urine flow. This catheter may stay in for a few days up to a week or more, depending on the procedure. Pain management will be provided, and patients are encouraged to begin light activity, such as walking, soon after surgery to aid recovery.
Life After BPH Surgery
After BPH surgery, the primary goal is to achieve improved urinary flow, reduced bothersome symptoms, and a better quality of life. Patients experience significant relief from urinary frequency, urgency, and a stronger urine stream. The full benefits may become apparent over several weeks to a few months as the treated area heals.
Side effects and complications
While surgical interventions for BPH aim to improve urinary function, some potential side effects and complications can occur. Retrograde ejaculation, where semen flows backward into the bladder during orgasm, is a common side effect, particularly with TURP, and can affect up to 75% of patients. While this does not impact the sensation of orgasm, it can affect fertility. Less common but possible complications include urinary incontinence (involuntary urine leakage) and erectile dysfunction, though these are temporary and can be managed with medication or other treatments.
Follow-up care
Follow-up care is an important aspect of recovery to monitor progress. Patients will have post-operative appointments to assess healing, remove catheters if still present, and check for any lingering symptoms or complications. Lifestyle adjustments can support long-term bladder health and overall well-being, including:
- Staying hydrated
- Eating a balanced diet
- Avoiding bladder irritants like caffeine and alcohol
- Engaging in regular, gentle physical activity