Introduction
Surgical options for benign prostatic hyperplasia (BPH) are typically considered when other treatments have not provided sufficient relief or when there are complications such as urinary retention, recurrent urinary tract infections, bladder stones, or kidney damage. Here are some common surgical options:
1- Transurethral Resection of the Prostate (TURP)
- TURP is the most common surgical procedure for treating BPH.
- During TURP, a surgeon uses a device called a resectoscope to remove portions of the enlarged prostate that are blocking urine flow.
- This procedure is performed through the urethra, so no external incisions are needed.
- TURP can provide significant relief of symptoms, but it may be associated with risks such as bleeding, urinary incontinence, erectile dysfunction, and retrograde ejaculation (ejaculation into the bladder instead of out of the penis).
2- Laser Prostate Surgery
- Several types of laser procedures can be used to treat BPH, including Holmium laser enucleation of the prostate (HoLEP), GreenLight laser therapy (photoselective vaporization of the prostate, PVP), and Thulium laser ablation.
- Laser surgery uses high-energy laser beams to remove or vaporize excess prostate tissue.
- These procedures are often associated with shorter hospital stays and quicker recovery times compared to TURP.
- Risks and potential complications vary depending on the specific type of laser surgery but may include urinary retention, urinary tract infections, and bleeding.
3- Transurethral Incision of the Prostate (TUIP)
- TUIP involves making small incisions in the prostate gland to widen the urethra and improve urine flow.
- This procedure is typically performed in men with smaller prostate glands and is associated with a lower risk of side effects such as retrograde ejaculation compared to TURP.
- While TUIP may provide symptom relief, it may not be as effective as more extensive surgical procedures for men with larger prostates or more severe symptoms.
3- Open Prostatectomy
- Open prostatectomy is a traditional surgical approach that involves making an incision in the lower abdomen to access and remove the enlarged portion of the prostate.
- This procedure is usually reserved for men with very large prostates or when other surgical options are not feasible.
- Open prostatectomy may be associated with a longer hospital stay and recovery period compared to minimally invasive procedures, but it can be highly effective in relieving symptoms.
4- Prostatic Urethral Lift (UroLift)
- UroLift is a minimally invasive procedure that involves inserting small implants into the prostate to hold the enlarged tissue away from the urethra, thereby relieving obstruction.
- This procedure is associated with minimal downtime and a low risk of sexual side effects such as erectile dysfunction or retrograde ejaculation.
- While UroLift can provide symptom relief, it may not be suitable for all men, particularly those with very large prostates or severe symptoms.
5- Transurethral Microwave Thermotherapy (TUMT)
- TUMT involves delivering microwave energy through a special catheter inserted into the urethra to heat and destroy excess prostate tissue.
- This procedure can be performed on an outpatient basis and typically does not require anesthesia.
- TUMT may be less effective than some other surgical options and may require repeat treatments for optimal results.
6- Transurethral Needle Ablation (TUNA)
- TUNA utilizes radiofrequency energy delivered through needles inserted into the prostate to heat and destroy excess tissue.
- This procedure is performed under local or regional anesthesia and can usually be completed in a single session.
- TUNA may cause less bleeding and have a lower risk of side effects compared to traditional surgery, but its effectiveness may vary.
7- Aquablation Therapy
- Aquablation therapy is a minimally invasive procedure that uses a high-velocity water jet to remove excess prostate tissue.
- During the procedure, a robotic system guides the water jet to precisely remove tissue while sparing surrounding structures.
- Aquablation therapy is relatively new and may not be widely available, but early studies have shown promising results in terms of symptom improvement and safety.
8- Prostate Artery Embolization (PAE)
- PAE is a minimally invasive procedure that involves blocking the blood supply to the prostate by injecting tiny particles into the arteries feeding the gland.
- Without adequate blood flow, the prostate shrinks over time, relieving urinary symptoms.
- PAE is typically performed by an interventional radiologist and may be an option for men who are not candidates for traditional surgery or prefer a less invasive approach.
Conclusion
Each surgical option for BPH has its own advantages, disadvantages, and considerations. The choice of procedure depends on factors such as the size of the prostate, the severity of symptoms, the patient's overall health, and their preferences. It's important for individuals considering surgical treatment for BPH to discuss their options thoroughly with their healthcare provider to determine the most appropriate course of action.
