One of the most common symptoms men face when they reach their sixties and seventies (sometimes even earlier), is benign prostatic hyperplasia (BPH). BPH may sound unfamiliar until called by its more common name, enlarged prostate.
The prostate is located just below the bladder, and it connects to the urethra, which is the tubular structure that carries urine from the bladder outside of your body when you urinate. When a prostate is enlarged, there is excess cell growth in the prostate. The prostate may press too tightly around the urethra, interfering with its normal flow. If your symptoms are extremely severe, you may be unable to urinate at all, which is an emergency that you should tell your urologist about right away.
Surgery is the most effective and longest lasting treatment of all of the options available for BPH today. Symptom improvement can last as long as 10 years. However, of all of the options, surgery is the one most likely to leave you with erectile dysfunction. If you are bothered a lot by BPH symptoms, you should weigh the pros and cons of this treatment option before choosing it.
Transurethral Resection of the Prostate (TURP)
A transurethral resection of the prostate (TURP) is the most common surgery performed for BPH. It is considered the gold standard treatment for BPH because it has been around the longest. It is the treatment that newer treatments are often compared to.
The surgery involves inserting a very small tubular camera or endoscope that is passed through the tip of the penis up through the urethra and into the bladder and removing excess tissue from the prostate.
During the first part of this procedure, the urologist checks for problems in the bladder itself, such as bladder tumors or stones. Assuming that the urologist finds no unexpected problems, an electrical loop is then placed up through the urethra and close to the area where prostate tissue is pressing up against the urethra. The loop removes excess tissue in the prostate. The electrical loop is also used to control bleeding where the surgery was performed.
The tissue that is removed is analyzed at a laboratory to ensure that no prostate cancer is present. A catheter is placed up through the urethra and bladder to collect your urine until you heal.
The procedure is usually done in the hospital under spinal anesthesia. Hospital stays are short, sometimes as short as one day under managed care. At discharge, you should be sure that your urologist gives you instructions on how to take care of yourself and a sense of potential complications.
Recovery After TURP
You should expect to have a urinary catheter in several hours to a few days. If you go home with a catheter, you will be seen by your urologist within a day or two of the procedure to have the catheter removed.
After returning home, men commonly see blood in the urine. Though alarming at first, this is often just a flushing out of scab material from the wound around surgery. However, if your urine is an intense red, contact your doctor immediately.
- Be sure that you rest in bed right after surgery and that you drink plenty of fluids. This will wash out any blood deposits and prevent a clot, which could lead to a blockage in your urinary tract.
- Avoid driving and heavy lifting.
- Do not strain when you are moving your bowels.
- If you are constipated, ask your doctor for advice on the best way is to handle it (whether taking a laxative is OK for you).
Side Effects of TURP
During the first few months after the procedure, you may experience urinary discomfort. At first, you may have a very strong urinary flow that you cannot control. However, your surgical wound area will be exposed once your catheter is out, so you may feel pain when you urinate. Within a few months, your urinary flow will stabilize, and uncontrollable urination or hesitation will subside.
Some men have complications from surgery. The main side effect that occurs is retrograde ejaculation. When you ejaculate, your semen will flow up toward your bladder, not out as it normally does. This may not be a concern for men who do not want to father children, but it is a common reason for male infertility.
Long-term erectile dysfunction and urinary incontinence are the symptoms that men worry about the most. Ask your doctor what proportion of men with your symptoms and profile end up with long-term erectile dysfunction and urinary incontinence. The chance of this happening is difficult to predict, however, because studies have figures all over the map. Urinary incontinence tends to me much less common (usually around 1%) than erectile dysfunction.
Possibility of More Extensive Surgery: Open Prostatectomy
Sometimes it is not possible to remove prostate tissue from a very large prostate using a transurethral procedure. Your doctor will not be able to get a large enough tube up the urethra, so an open prostatectomy -- the surgical removal of the entire prostate -- may be necessary.
Other reasons that you may need an open procedure include having bladder stones or an inability to place your legs in stirrups to allow for TURP or minimally invasive surgical procedures to be performed.
Because it is open surgery, you will be in the hospital for a few days, and you will have more pain than that with less invasive procedures,
Symptom Improvement With Surgery for BPH
Overall improvement in patient symptoms, according to the American Urological Association, is as follows:
- TURP: 88%
- Open Prostatectomy: 98%
Presti JC, Kane CJ, Shinohara K, Carroll. PR. Neoplasms of the prostate gland. Chapt. 22. In: Tanagho and McAninch, eds. Smith's General Urology. 17th ed. New York: McGraw Hill.
Surgical management of BPH. American Urological Association Foundation. Downloaded Oct. 22, 2009.
Tanguay S, Awde M, Brock G, Casey R, et al. Diagnosis and management of benign prostatic hyperplasia in primary care. Can Urol Assoc J 2009 (3Suppl2):S92-S100.