Enlarged Prostate Procedures

ANATOMY

The prostate gland is located just below the bladder at the site where the bladder connects to the urethra. The urethra is a tube inside the penis that carries urine and semen out of the body. It courses through the prostate and the penis. The prostate gland is the size and shape of a chestnut in a man’s early life, enlarging later in life to variable sizes and shapes. It has an important role in sexual function producing semen, which supports sperm nourishment and transport.

SURGERY

Surgery is most commonly recommended for men experiencing severe and persistent symptoms due to an obstructing prostate. There are many different types of surgeries that may be performed. With your vital input, your physician will choose the surgery that best fits your specific case.

Some of these surgeries include:

Transurethral Resection of the Prostate (TURP). Transurethral surgery is the most common form of surgery for treatment of an obstructing prostate and is currently considered the gold standard. With this surgery, there are no external incisions making it is less traumatic than procedures that require external incisions. TURP also boasts the highest success rate over all other procedures (except total removal of the prostate) in improving flow rates. A modified cystoscope called a resectoscope is inserted through the urethra and uses an electrical wire loop that cuts tissue away from the center of the enlarged prostate TURP is a preferred technique for medium to large glands.

Transurethral Incision of the Prostate (TUIP). A similar procedure called transurethral incision of the prostate is performed through the urethra, enlarging the urethra by making an incision in the prostate and bladder neck. TUIP is most useful for small to medium glands with obstructing tissue at the bladder neck. This promising surgery has received good reviews but its advantages and long-term side effects have not yet been clearly established.

Urethral Stent. A wire mesh stent is placed in the urethra within the prostate to gently hold the urethra open to allow the passage of urine. This is a permanent stent placed in an outpatient setting with a special delivery tool and a cystoscope, a tool that allows a lighted view of the urethra, prostate, and bladder.

Open Surgery. When transurethral surgery is not a viable option due to a very large gland, an open prostate surgery, called an open simple prostatectomy, is performed. This form of surgery is usually performed in the case of a significantly enlarged prostate greater than 100 cc in volume. In this surgery, an incision is made in the lower abdomen just above the pubic area. The interior of the prostate is removed, leaving a shell of compressed normal prostate tissue. A significant increase in urinary flow is commonly seen after this surgery with the greatest increase in urinary flow of all treatment techniques.

RECOVERY

Under normal circumstances, you will feel good enough to move around a bit and have something to eat. Your stay in the hospital should be uneventful, lasting 2-3 days. You will have a catheter in place and it will remain for a few weeks.

Once home, special care must be taken of the catheter, including routine checks to make sure it is still in place and clean. Same goes for the opening of the penis. You want to make sure an infection doesn’t occur.

Over-the-counter medications like ibuprofen might be enough to manage pain, but don’t be afraid to ask your physician for stronger prescription medications should you feel the need.

You may feel surprisingly good after the surgery, but don’t go overboard. Avoid lifting anything heavier than 10-15 pounds for at least 6 weeks. Many patients can quickly return to work, as long as it’s not too strenuous.

IS SURGERY FOR ME?

With the guidance of your physician, only you can make the final decision on whether to go through with surgery. You must weigh the risks versus the rewards and try to envision your life after surgery. Look past the short-term pain associated with the procedure and try to imagine the impact on your lifestyle. Once you review the pros and cons with your physician and understand the procedure to the best of your ability, only then can you make the decision right for you.