Benign Prostatic Hyperplasia

Treatment - Surgery

There are 3 surgical procedures that are time-proven for the treatment of BPH. They all have in common that they require anesthesia and have to be performed in the operating room. In most cases, you also will have to stay for 1 night or longer in the hospital. The choice between these procedures is usually made based on the size of the prostate as determined by DRE or transrectal ultrasound.

• Transurethral Incision of the Prostate (TUIP)
• Transurethral Resection of the Prostate (TURP)
• Open Prostatectomy

Transurethral Incision of the Prostate (TUIP)

If the prostate is relatively small, i.e. under 30 grams by TRUS, or by DRE estimates, a simple incision of the bladder neck and prostate can be very helpful in improving your symptoms and the urinary flow. This is a very quick procedure, usually takes no longer than 10 to 15 minutes, and you can leave the hospital either on the same day or the next morning. The physician may leave a catheter indwelling either over night or for a longer period of time depending on the depth of the incision.

This operation is highly effective in small prostates and re-treatments or treatment failures are relatively uncommon.

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Transurethral Resection of the Prostate (TURP)

The most commonly performed procedure for the prostate is a TURP. Using electrocautery energy, the prostate is removed in bits and pieces through the urethra with a specially designed telescope and electrocautery loop. The urologic surgeon can carve the prostate out in an anatomically correct manner to create a cavity that allows for an improved urinary flow and greatly alleviate the symptoms. This operation has to be done under general or spinal anesthesia, it takes approximately 60 minutes and you have to stay at least 1 night in the hospital. Usually the catheter is removed the morning after the surgery and you are likely to be able to go home on the afternoon of the day after surgery.

This operation has been performed for decades and is extremely reliable and durable.

Some of the more common complications are the retrograde flow of semen known as retrograde ejaculation which occurs in 2 out of 3 patients. Scarring in the urethra or around the bladder neck can occur in 2 out of 100 patients, and very few patients experience erectile dysfunction as a result of this intervention.

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Open Prostatectomy

For prostates that cannot safely be resected within 60 minutes(these are usually prostates over 100 grams by transrectal ultrasound) the best procedure is an open enucleation of the prostate. To do this, the surgeon will make an incision in your lower abdomen which is either a length-wise or transverse incision. Through this incision, he will expose the prostate and remove the growth from within the prostatic capsule. You can think of it as a grapefruit or orange. The meat represents the growth of the prostate that has to be removed and the capsule of the prostate is represented by the rind of the orange or grapefruit. By leaving the rind or capsule behind, the continuity of the urinary tract from the bladder through the prostate to the urethra is maintained and healing is facilitated. This operation takes approximately 90 minutes and you will have to stay in the hospital for a minimum of 2 to 3 days. The operation is highly successful for very large prostates and complications are similar to those of a TURP: 2 out of 3 patients have retrograde flow of semen, less than 5 out of 100 have scarring at the bladder neck or in the urethra, and some patients experience erectile dysfunction.

Other than electrocautery, laser energy has been recently used to remove prostatic tissue. Most notably, the Holmium laser has provided an alternative energy source to effectively reduce prostate tissue.

Physicians at the Prostate Disease Center at UT Southwestern are actively engaged in research exploring new ways of treating an enlarged prostate with medical therapies, minimally invasive therapies, and ultimately by surgery.

Among the most important studies in BPH is the MTOPS or Medical Therapy of Prostate Symptoms study. This is a 5 year study comparing two different individual medications with a combination of both medications and a placebo or no treatment arm. Over 200 patients participate in this trial at UT Southwestern, and over 3000 nationwide.

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More information:

Investigational

MIST Therapies

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For more information about the Department of Urology, contact:

Phone: 214-648-4765, FAX: 214-648-4789

Mailing Address:  5323 Harry Hines Blvd., Dallas, TX  75390-9110