Enlarged Prostate: Is It Time for Prostate Surgery?

While medications help many men with an enlarged prostate -- also called benign prostatic hyperplasia (BPH) -- they may not always be effective in relieving symptoms. You have other options in treating an enlarged prostate.

Taking the Next Step in Treating an Enlarged Prostate

Minimally invasive and surgical procedures are available to treat moderate-to-severe enlarged prostate symptoms that are bothersome. These procedures are also used if tests show that your urinary function is seriously affected.

Each treatment has benefits and risks, and some treatments can help certain patients more than others.

As you discuss the options, ask your doctor these five questions:

1. Is there a good chance my condition will improve?
2. How much will it improve?
3. What are the chances of side effects from a treatment?
4. How long will the effects last?
5. Will I need to have this treatment repeated?

Minimally Invasive Procedures for an Enlarged Prostate

Minimally invasive procedures for an enlarged prostate are often performed in a doctor’s office. Overall these procedures are better than medications at relieving symptoms, but they are less effective than surgery. 

• Transurethral microwave therapy (TUMT). This procedure uses a microwave antenna attached to a flexible tube that is inserted into the bladder. The microwave heat destroys excess prostate tissue.
• Transurethral needle ablation (TUNA). This procedure uses a heated needle inserted into the prostate through the urethra to destroy excess prostate tissue.

Surgery for an Enlarged Prostate

Most men have tried medications for their enlarged prostate before discussing surgery. However, some men may wish to move directly to surgery if their symptoms are particularly bothersome. As with any treatment decision, it’s important to fully discuss the risks and benefits with your doctor.

Surgery is often considered the best long-term solution for relief of BPH symptoms. Most surgical procedures involve removing the enlarged part of the prostate.  

Surgery is usually recommended in treating BPH-related complications, such as:

• Urinary retention (inability to urinate)
• Failure to respond to medical or minimally invasive treatments
• Blood in the urine that is not getting better
• Bladder stones
• Frequent urinary tract infections
• Kidney damage

The surgical procedures include:

• Transurethral resection of the prostate (TURP). In this surgery the inner portion of the prostate is removed. This is the most commonly used surgical procedure for BPH; it’s used in 90% of BPH surgeries. And it’s considered the best of endoscopic surgical treatments for enlarged prostate, although other surgical procedures are acceptable alternatives. No external scars are seen since the scope is inserted thorough the urethra. 
• Open prostatectomy (open surgery). This surgery is often done when the prostate is greatly enlarged, when there are complications, or when the bladder has been damaged and needs repair. In open surgery, the surgeon makes an incision and removes the enlarged tissue from the prostate. 
• Laser surgery. Laser surgery uses laser energy to destroy prostate tissue and shrink the prostate. Laser surgery may not be effective on larger prostates.
• Transurethral incision of the prostate (TUIP). This surgery does not involve removing prostate tissue. A few small cuts are made in the prostate gland to reduce the prostate’s pressure on the urethra, making urination easier. This procedure is an option for some men, such as those with smaller prostates.