Should I Get Surgery for My Enlarged Prostate?

The key factor in determining whether you should have surgery for enlarged prostate is the cause of the enlarged prostate. If your prostate enlargement is caused by cell growth in the tissues surrounding the urethra, non-surgical treatment may alleviate your symptoms. If, however, the prostate is enlarged because of middle lobe prostate growth, the cells are growing into the urethra and the area around the bladder outlet. Correcting this form of enlarged prostate will likely require surgery.

How invasive?

All enlarged prostate surgery is definitely not the same. Surgical options vary from minimally invasive procedures involving thermal or laser application to more comprehensive solutions, up to removal of the prostate (prostatectomy). The choice will depend on your physician's evaluation of your general health and risk factors.

Laser, Microwave, and Ultrasound

Advances in technology have created some less invasive means for alleviating symptoms. These forms of enlarged prostate surgery are often performed in the urologist's office and may require little or no anesthesia. If lasers are used, they work by directing a high-energy beam of light against obstructing tissues. The tissues are vaporized and the area of treatment is sealed. Usually, the procedure takes about 30 to 60 minutes. Patients can sometimes experience bloody urine for a week or so. Usually a catheter will be necessary until full bladder function returns. Some sexual side effects may also occur in rare cases. In microwave treatment, an antenna, sealed inside a catheter, is introduced into the prostate through the urethra. Heat is directed into the obstructing tissue to destroy it. The destroyed tissue is either reabsorbed by the body or eliminated through the urinary tract over a period of a few weeks. Sometimes temporary catheterization is necessary to promote proper drainage, and some patients experience mild side effects that usually subside after a few weeks. Ultrasound therapy is a new procedure undergoing clinical trials, in which high-energy sound waves are used to heat and destroy obstructing tissues.

Other Surgical Procedures

Trans-urethral resection of the prostate (TURP) is a form of enlarged prostate surgery in which the surgeon inserts a resectoscope into the urethral opening in the penis, then surgically removes obstructing tissue. The resectoscope is a small, tubular device that contains a light, valves for controlling irrigating fluid, and an electrical loop for removing tissue and sealing blood vessels. The obstructing tissue is removed, the area is irrigated with fluid to flush debris into the bladder, and the area is sealed. This procedure usually involves a 3-day hospital stay. Up to 30% of men who have this procedure experience some sexual side effects, but these often resolve over time.