Prostate Enlargement/BPH Health Center

Enlarged Prostate: A Complex Problem

Surgery for an Enlarged Prostate continued...

With the TURP procedure, patients can expect to have retrograde ejaculation afterwards, says Westney. This is a condition in which a man ejaculates backward into the bladder instead of through the urethra. "Retrograde ejaculation generally isn't painful," she tells WebMD. "It shouldn't be an issue unless fertility is a concern." Other possible side effects include blood loss requiring transfusion (rare), painful urination, recurring urinary tract infections, bladder neck narrowing, and blood in the urine.

After TURP, the odds of erection problems range from 5% to 35%. However, this is often temporary -- and the ability to have an erection and an orgasm returns after a few months.

TUIP (transurethral incision of the prostate): This procedure involves making cuts in the prostate instead of removing prostate tissue. These cuts reduce pressure on the urethra, making urination easier. Patients go home the same day, and wear a catheter for a day or two.

Symptom relief is slower with TUIP, compared with TURP. However, most men are satisfied with their ultimate symptom relief from this. Also, retrograde ejaculation is less common and less severe than after TURP. Risk of erection problems is similar to TURP.

Laser Surgery: This procedure uses a high energy vaporizing laser to destroy prostate tissue. It is done under general anesthesia and may require an overnight stay at the hospital. It provides immediate relief of symptoms, yet men may suffer from painful urination for a few weeks. In general this procedure causes less blood loss, and side effects can include retrograde ejaculation. These procedures include:

• Transurethral holmium laser ablation of the prostate (HoLAP)
• Transurethral holmium laser enucleation of the prostate (HoLEP)
• Holmium laser resection of the prostate (HoLRP)
• Photoselective vaporization of the prostate (PVP)

Open Prostate Surgery (Prostatectomy): When a transurethral procedure cannot be used, open surgery (which requires an incision in the abdomen) may be used. This allows the surgeon to remove tissue in the prostate. Open prostatectomy is typically done when the prostate gland is greatly enlarged, when there is bladder damage, if there are bladder stones, or if the urethra is narrowed. The inner part of the prostate is removed. This surgery is done under general or spinal anesthesia, and recovery can take a few weeks to several months.

Side effects are similar to TURP, including blood loss requiring a transfusion, urinary incontinence, erection problems, and retrograde ejaculation.

Herbal Therapies for an Enlarged Prostate

Several herbal supplements are marketed for enlarged prostates. Saw palmetto, beta-sitosterol, and pygeum are all are widely used in Europe. They are available in the U.S. and don't require a prescription.

However, researchers and doctors are cautious about advising patients to try herbal supplements. Because they are not FDA-regulated, there are concerns about a product's quality from batch to batch, according to the NIH's Office of Dietary Supplements. Also, the safety of an herbal product depends on many things -- the chemical makeup, how it works in the body, how it is prepared, and the dosage.