More Invasive Surgery

More Invasive Surgery

In severe cases of BPH or when other options fail, more invasive surgery is recommended. Surgery is best if you:

• Are unable to pass urine
• Have kidney damage
• Have frequent urinary tract infections
• Have a lot of bleeding
• Have stones in the bladder

There are several types of more invasive surgery options from which to choose. The option will depend on your health, your doctor’s expertise and your personal choice. Options below appear in order of least invasive to most invasive.

Transurethral incision of the prostate (TUIP) is used to widen the urethra if the prostate gland is small but causes a major blockage. For TUIP, the surgeon makes small cuts in the bladder neck, where the urethra joins the bladder and in the prostate. This widens the urethra and reduces the pressure of the prostate on the urethra, making urination easier. The hospital stay is one to three days. A catheter is left in your bladder for one to three days after surgery. Some men need follow-up treatment. Men who do not want a complete prostatectomy (removal of the prostate) but need surgery are good candidates.

Photoselective vaporization (PVP) is a way to vaporize prostate tissue with a high-powered laser. Most men can have a PVP without problems. The procedure is done as an outpatient procedure at the hospital or sometimes in the doctor’s office. There are few side effects. After PVP, most men can stop medical therapy. This method is useful for most men except those with the largest of prostates. Because this method causes very little blood loss it is particularly useful in men with a higher risk of bleeding, such as those taking blood-thinning medications or those with weak hearts.

Transurethral resection of the prostate (TURP) is a common surgery for BPH.TURP uses electric current or laser light to cut and remove tissue. This is done with anesthesia and a tool called a resectoscope inserted through the penis. The resectoscope provides light, irrigating fluid and an electrical loop. The loop cuts tissue and seals blood vessels. The removed tissue is flushed into the bladder and out of the body with a catheter. Men who require surgery because of moderate to severe BPH symptoms may be good candidates for TURP.

Diagram of Transurethral Resection of the Prostate (TURP)

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Holmium laser enucleation of prostate (HoLEP) is when a surgeon places a resectoscope through the penis into the urethra. A laser inserted into the resectoscope destroys excess prostate tissue. No incisions (cuts) are needed and there is very little bleeding. You may only need to stay one night in the hospital. A catheter is used, but it is usually removed the next day. Men with larger prostates who wish to avoid more-invasive surgery may be good candidates for this treatment. Men with a higher risk of bleeding, such as those taking blood-thinning medications, may also be good candidates for HoLEP.

Thulium laser enucleation of the prostate (ThuLEP) is similar to HoLEP but uses a different type of laser. As in HoLEP, the surgeon places a resectoscope through the penis into the urethra. A laser inserted into the resectoscope destroys excess prostate tissue. Men with larger prostates who wish to avoid more-invasive surgery may be good candidates for this treatment. No incisions (cuts) are needed and there is very little bleeding. You may only need to stay one night in the hospital. A catheter is used, but it is usually removed the next day. Men with a higher risk of bleeding, such as those taking blood-thinning medications, may also be good candidates for ThuLEP.

Transurethral vaporization of the prostate (TUVP) is when the surgeon inserts a resectoscope into the urethra with a lens, a light, and a tool that sends out an electrical current to destroy prostate tissue. Heat from the electrical current seals small blood vessels, reducing the risk of bleeding. There is little bleeding or fluid absorption. You may stay one night in the hospital and you can usually return home without a catheter. Men with larger prostates who wish to avoid more-invasive surgery may be good candidates for TUVP.

Transurethral water–jet ablation (TWJA) uses high-pressure water jets to destroy excess prostate tissue. The surgeon first uses ultrasound to precisely map the location of the excess tissue. Then the high-pressure water jets are directed to that area. Following this, the surgeon inserts another instrument to seal small blood vessels to reduce the risk of bleeding. The patient needs to stay in the hospital one night to irrigate the bladder to prevent blood clots. You may need to use a catheter for about 48 hours after the procedure and should be able to go home the next day.

Simple prostatectomy removes the entire prostate gland with laparoscopic or robotic-assisted surgery. It is important for the surgeon to be skilled at this surgery. This is only offered to men with the largest of prostate glands. This is a long- term cure. You will probably stay in the hospital for a few days after surgery and your activities will be limited for several weeks. A catheter will usually be needed for 1 to 2 weeks while you heal.

What to Expect After Surgery

For most men, symptoms of BPH improve after treatment. After surgery, it can take time for sexual function to return fully. Most experts believe that if you were able to have an erection shortly before surgery, you will be able to after surgery. Your orgasm is not expected to change. In some cases, men can experience an issue where semen enters the bladder rather than out the penis (retrograde ejaculation.)

Infection, bleeding and incontinence may also occur after some BPH treatments. In some cases, scar tissue may form. Side effects vary with the type of treatment you choose and most side effects are temporary. Some men need further or new treatment for their BPH symptoms after initial treatment.

It is of great value to tell your doctor about any side effect you may have to get help.