My BPH Won't Go Away. What Are My Surgical Options?

Benign prostatic hyperplasia (BPH), an enlargement of the prostate gland, can cause problems with urination and have a significant effect on your quality of life. Fortunately, some minimally invasive surgical procedures can reduce prostate size and improve urinary flow.

Transurethral resection of the prostate (TURP)

During a transurethral resection of the prostate (TURP), a surgeon removes areas of an enlarged prostate without making any incisions. A tool called a resectoscope is used to access the prostate through the penis. Resectoscopes are long and thin, about a foot long and less than a half-inch in diameter. The surgeon guides the attached electrical wire loop to remove excess tissue that's blocking the urethra.

Irrigating fluid is released through valves within the resectoscope. This fluid carries removed tissue bits to the bladder, where they can be flushed out of the body. The resectoscope also has a camera with a light to give the surgeon a clear view of the procedure in progress.

The initial recovery phase at the hospital is one to two days, but you'll need to wait at least two weeks before resuming strenuous activities, including sex, stair climbing and lifting more than 10 pounds. Stool softeners may be recommended to avoid straining during bowel movements. Your doctor may send you home with a catheter, which will need to be removed at the hospital a few days later.

Some blood in the urine is normal during the first six weeks after TURP, but you should contact your doctor right away if you experience heavy bleeding or blood clots, a fever above 101 degrees or sudden difficulty urinating.

Holmium laser enucleation of the prostate (HoLEP)

Holmium laser enucleation of the prostate (HoLEP) is similar to TURP, except the resectoscope has a laser attached rather than an electrical wire loop. The laser is used to remove excess prostate tissue. HoLEP has been around since the 1990s with a good track record. After the laser finishes its job of breaking up extra tissue, it is taken off the resectoscope and replaced by a device called a morcellator, which suctions out tissue that was left behind in the bladder.

The risks and recovery time for HoLEP are comparable to those for TURP. You should plan to be in the hospital for at least one night and give yourself a couple of weeks off work to recover at home following the procedure.

UroLift

The UroLift procedure avoids the removal of prostate tissue altogether. Instead, small implants are placed near the prostate to lift and hold tissue out of the way, alleviating blockage of the urethra. First, a surgeon inserts the UroLift device through the urethra. Once the device meets the enlarged prostate, it compresses the tissue and applies tiny implants that "tie-back" each side of the prostate gland. This creates an opening for better urine flow. Once finished, the UroLift device is removed.

Unlike the above procedures, which are typically performed under general anesthesia, UroLift can be done under local anesthesia, reducing some risks and recovery time. You should be able to go home the same day, and a catheter isn't usually required.

Complications and outlook

Minimally invasive procedures for benign prostatic hyperplasia involve less risk than invasive surgery and can be an excellent option for people who don't respond well to medication. However, the procedures are not risk-free. Some of the potential complications may include:

• Chronic inflammation of the prostate
• Incontinence
• Pain or difficulty urinating
• Sexual dysfunction
• Urinary tract infections (UTIs) and urinary retention
• Urinary urgency

Unlike other BPH procedures, the UroLift treatment doesn't affect ejaculation or erectile function. Long-term studies aren't yet available for UroLift, but many men have satisfactory results for at least five years following the procedure. If eventually needed, TURP, HoLEP or more invasive surgery can be done on patients who have had the UroLift.

An experienced urologist can help you weigh the pros and cons of different treatment options and determine the best way to improve your BPH symptoms.