Prostatectomy Is The Most Common BPH Surgery For A Reason
Prostatectomy is the most common surgical treatment of benign prostatic hyperplasia (BPH), which is a noncancerous (benign) enlargement of the prostate gland that can make urination difficult.
- The prostate gland enlarges as men age.
- Men may have difficulty urinating and feel the need to urinate more often and more urgently.
- Usually, the diagnosis is based on the results of a rectal examination, but a blood sample may be taken to check for prostate cancer.
- If needed, drugs to relax the muscles of the prostate and bladder (such as terazosin) or to shrink the prostate (such as finasteride) are used, but sometimes surgery is necessary.
The prostate is a gland in men that lies just under the bladder and surrounds the urethra. The gland, along with the nearby seminal vesicles, produces much of the fluid that makes up a man’s ejaculate (semen). The prostate is walnut-sized in young men but enlarges with age. As the prostate enlarges, it gradually compresses the urethra and blocks the flow of urine (urinary obstruction). When men with BPH urinate, the bladder may not empty completely. Consequently, urine stagnates in the bladder, making men susceptible to urinary tract infections (UTIs) and bladder stones. Prolonged obstruction can weaken the bladder and ultimately damage the kidneys.
Prostatectomy
Prostatectomy is a very common operation. About 200,000 of these procedures are carried out annually in the U.S. A prostatectomy for benign disease (BPH) involves removal of only the inner portion of the prostate (simple prostatectomy). This operation differs from a radical prostatectomy for cancer, in which all prostate tissue is removed. Simple prostatectomy offers the best and fastest chance to improve BPH symptoms, but it may not totally alleviate discomfort. For example, surgery may relieve the obstruction, but symptoms may persist due to bladder abnormalities.
Surgery causes the greatest number of long-term complications, including:
- Impotence
- Incontinence
- Retrograde ejaculation (ejaculation of semen into the bladder rather than through the penis)
- The need for a second operation (in 10% of patients after five years) due to continued prostate growth or a urethra stricture resulting from surgery
While retrograde ejaculation carries no risk, it may cause infertility and anxiety. The frequency of these complications depends on the type of surgery.
Surgery is delayed until any urinary tract infection is successfully treated and kidney function is stabilized (if urinary retention has resulted in kidney damage). Men taking aspirin should stop seven to 10 days before surgery, since aspirin interferes with blood’s ability to clot.
Transfusions are required in about 6% of patients after TURP and 15% of patients after open prostatectomy.
Since the timing of prostate surgery is elective, men who may need a transfusion — primarily those with a very large prostate, who are more likely to experience significant blood loss — have the option of donating their own blood in advance, in case they need it during or after surgery. This option is referred to as an autologous blood transfusion.
Other types of surgery
Current surgical options include monopolar and bipolar transurethral resection of the prostate (TURP), robotic simple prostatectomy (retropubic, suprapubic and laparoscopic), transurethral incision of the prostate, bipolar transurethral vaporization of the prostate (TUVP), photoselective vaporization of the prostate (PVP), prostatic urethral lift (PUL), thermal ablation using transurethral microwave therapy (TUMT), water vapor thermal therapy, transurethral needle ablation (TUNA) of the prostate and enucleation using holmium (HoLEP) or thulium (ThuLEP) laser.
