Benign Prostatic Hyperplasia (BPH) is the non-cancerous enlargement of the prostate gland, situated just below the bladder and wrapping around the urethra. As the prostate grows, it can compress the urethra, obstructing urine flow and leading to bothersome lower urinary tract symptoms (LUTS). These symptoms commonly include a weak stream, frequent urination (especially at night), and the feeling that the bladder is not completely empty. Initial management typically involves lifestyle adjustments and medication, such as alpha-blockers or 5-alpha reductase inhibitors, to relax the prostate muscle or shrink the gland.
Surgical intervention is generally reserved for patients with severe symptoms, those who have failed medical therapy, or when complications like recurrent urinary tract infections, bladder stones, or kidney issues develop. The primary goal of surgery is to remove or reduce the obstructive prostate tissue to widen the urinary channel and improve the quality of life. The choice of procedure depends on factors like the size of the prostate, the patient’s overall health, and their preference regarding potential side effects.
Established Surgical Approaches
The benchmark for surgical treatment of BPH is Transurethral Resection of the Prostate (TURP), often considered the gold standard for larger prostates or severe obstruction. The procedure involves inserting a resectoscope through the urethra. This instrument uses an electrical wire loop to precisely cut away small chips of the excess prostate tissue blocking the urinary pathway. The removed tissue fragments are then flushed out of the bladder. TURP offers predictable, long-lasting results, but it is more invasive than newer options, typically requiring a hospital stay of one to four days and carrying a moderate risk of bleeding.
A variant, Transurethral Incision of the Prostate (TUIP), is a less aggressive option used for men with smaller prostates. TUIP involves making one or two small incisions in the prostate at the bladder neck to widen the channel, rather than removing tissue. Since no tissue is removed, TUIP has a lower risk of bleeding and fewer sexual side effects compared to TURP. It is often performed as an outpatient procedure, allowing patients to return to normal activities more quickly. Both TURP and TUIP are performed entirely through the urethra, requiring no external skin incision.
Minimally Invasive Treatments
Less-invasive procedures reduce recovery time and risk for many men, particularly those with smaller to moderately enlarged prostates. These techniques often preserve sexual function while still providing durable symptom relief. One category is tissue ablation, which uses energy to remove or destroy the obstructing tissue.
GreenLight Laser Photoselective Vaporization of the Prostate (PVP) uses a high-powered laser fiber passed through a cystoscope to vaporize the obstructive tissue on contact. This procedure offers rapid symptom improvement with a virtually bloodless outcome, making it suitable for men taking blood thinners. Holmium Laser Enucleation of the Prostate (HoLEP) is a different laser technique that surgically removes the entire inner portion of the prostate through the urethra. HoLEP is effective for very large prostates and provides tissue for pathological examination, with a low retreatment rate.
Water Vapor Thermal Therapy, known as Rezūm, uses the energy stored in steam to treat the enlarged prostate tissue. Sterile water vapor is injected into the prostate, and the thermal energy causes the prostate cells to die, leading to tissue reduction over several weeks. Rezūm is an office-based procedure, and its primary advantage is the preservation of both erectile and ejaculatory function.
Prostatic Urethral Lift (PUL), commonly referred to as UroLift, employs a mechanical approach to open the obstructed urethra without removing any tissue. Small, permanent implants are placed to pull the enlarged prostate lobes apart, immediately relieving compression on the urethra. This procedure is typically performed in an outpatient setting and offers fast symptomatic relief with minimal impact on sexual function.
Recovery and Post-Surgical Expectations
Recovery time varies based on the procedure performed. A temporary urinary catheter is often required immediately after surgery to drain the bladder, as the urethra and prostate may be swollen. For less-invasive procedures like UroLift or Rezūm, catheterization may last only a few days, while traditional TURP may require it for longer.
Patients commonly see blood in the urine (hematuria) for several days or weeks. They may also experience a burning sensation during urination, along with urinary urgency and frequency, as the bladder adjusts to the improved flow. Surgeons advise against heavy lifting, straining, or strenuous activity for four to six weeks to prevent bleeding.
A common long-term change after many BPH surgeries, particularly TURP and laser ablations, is retrograde ejaculation. This occurs when semen flows backward into the bladder during orgasm, resulting in a “dry orgasm.” Procedures like UroLift and Rezūm have significantly lower rates of this side effect, making them appealing for men prioritizing sexual function preservation.