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Enlarged Prostate (cont.)

Is Surgery an Effective Treatment for an Enlarged Prostate?

  • A common operation for treatment of prostate enlargement is transurethral resection of the prostate (TURP) and is considered the gold standard. In this procedure, the doctor scrapes away the innermost core of the prostate through a small instrument inserted through the urethra. The surgery reduces pressure on the urethra and generally gives relief from symptoms.
  • A more limited operation called transurethral incision of the prostate (TUIP) may be an option for some men. In this operation, instead of removing prostate tissue, the doctor passes an instrument through the urethra to make one or two small cuts in the prostate. These cuts reduce the prostate's pressure on the urethra, making urination easier.
  • Several newer treatments that may be performed in the office with local anesthetic alone or supplemented by sedation have been introduced and may be effective for men with an enlarged prostate. These include a treatment known as Rezum therapy, which consists of injecting a water steam into the prostate under local anesthetic; the Urolift procedure, which consists of placing small suture implants to hold the prostate tissue apart from around the urethra; transurethral microwave thermotherapy (TUMT), transurethral radiofrequency needle ablation of the prostate (TUNA), and interstitial laser coagulation (ILC). The general principle of all these treatments is similar. In each case, the prostate tissue is heated to a level that will lead to death of portions of the prostate tissue, thus shrinking away and removing some of the obstruction.
  • The Rezum and Urolift procedures have the advantage of preserving ejaculatory function, which can be affected by almost all other prostate procedures. These can also be done in the office without the need for anesthesia.
  • Another popular new treatment is photovaporization of the prostate (PVP) or laser ablation of the prostate, in which a laser is used to directly remove or vaporize prostate tissue in a similar fashion to what is accomplished with a TURP (see above) with much less bleeding. The advantage of this technique compared with TUMT, TUNA, or ILC is that it offers immediate removal of tissue with rapid improvement in symptoms. Conversely, these other three treatments lead to delayed tissue loss and are not associated with immediate improvement of urinary symptoms in most cases.
  • Other new surgical alternatives are being evaluated by the FDA for approval in the U.S. (like the AquaBeam ablation procedure, which also preserves ejaculatory function). Ask your doctor about the potential risks and benefits of medication and surgery. An operation for an enlarged prostate does not eliminate the risk of developing prostate cancer.
  • Holmium laser enucleation of the prostate (HoLEP) is a procedure that is offered in specialized centers and allows larger prostates to be enucleated (shelled out).
  • Sometimes for very large prostates, a procedure called simple prostatectomy is indicated, which is traditionally done by open surgery. A minimally invasive procedure can be done in specialized centers where the enlarged part of the prostate (referred to as the adenoma) is removed laparoscopically or with a surgical robot through keyhole incisions instead of the open surgical incision.
Medically Reviewed by a Doctor on 9/11/2017
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