Dr. Maxx Keegan Caveney, MD

Medication can relieve mild to moderate symptoms of BPH, such as frequent urination, incomplete bladder emptying, a weak urine stream, and straining while urinating. However, other forms of treatment may be more appropriate if an individual has pain with urination, frequent urinary tract infections, or is unable to urinate. The size of the prostate and the severity of their symptoms will determine the type of treatment they need. If the prostate is not very large, doctors will likely recommend a transurethral procedure. This minimally invasive technique involves the insertion of a scope into the urethra. The most common transurethral procedures for BPH are:

• Transurethral incision of the prostate or TUIP, where the surgeon uses the scope to make small cuts in the area of the prostate that meets the bladder. These cuts will open up the pathway for urine and allow it to flow with more ease.
• Transurethral needle ablation or TUNA, where needles are inserted through the scope and into the prostate. The needles use radiofrequency waves to destroy excess prostate tissue.
• Laser prostate ablation, where lasers pass through the scope to melt away the part of the prostate causing urine blockage.
• Transurethral resection of the prostate or TURP, where the inside of the prostate is trimmed and removed one tiny piece at a time using the scope.

If the prostate is too big for a transurethral procedure, an individual may need a simple prostatectomy, which can be done in one of three ways: laparoscopic, robotic, or open. During a laparoscopic simple prostatectomy, a surgeon makes several small incisions on the belly. Then they insert a long tube with a camera into one of the cuts and surgical instruments into the others. Using the camera to see inside the belly, they carefully removes the enlarged part of the prostate. Robotic simple prostatectomy uses the same techniques as the laparoscopic method, but the surgery is done with the help of a robot. For men with very large prostates, open simple prostatectomy may be the best treatment option. This surgery differs from the other approaches in that it requires a much larger incision.

Most transurethral treatments for BPH, like TUIP, TUNA, and laser prostate ablation, are done in the doctor's office or outpatient surgery center. TURP and simple prostatectomy, however, need to be performed in the hospital and require an average stay of one to three days. Patients should wait a week before doing any strenuous activities after a TUIP, TUNA, or laser prostate ablation, and about four to six weeks after a TURP or simple prostatectomy. Although these treatments improve BPH symptoms for most patients, it is important to be aware of the risks involved, such as urine control issues, tightening of the urethra, and erectile dysfunction.

For men, the incision is placed between the base of the scrotum and anus. The incision can be made on the abdomen or in the vagina for women. If a surgeon uses a patient's own tissue to form the sling, she will most likely perform the procedure through the abdominal incision. This approach requires a hospital stay of a few days and down time of a few weeks. Surgery to insert synthetic slings is typically done vaginally. It is performed at an outpatient facility, and most normal activities can be resumed within seven to ten days.

Although recovery is shorter with synthetic slings than with slings made from the patient's own tissue, synthetic slings are associated with a complication known as mesh erosion. When synthetic mesh erodes, it pushes through the vaginal wall and sometimes becomes exposed, causing long-term pain and infections. If this complication occurs, the patient may need to have another surgery to remove the mesh.

Implantation of the prosthesis is performed through an incision in the abdomen or scrotum. Depending on the type of implant, penile implant surgery will be completed within one to three hours. Recovery following penile implant surgery will usually take one or two days, and

implants may last indefinitely. However, there are risks associated with implants, including breakage, leakage, and infection. Broken or infected implants are treated by removal, repair, or replacement.

Following implantation, patients may return to full physical and sexual activity in about a month. Patients may need to take medication to ease pain and prevent infection, and they should avoid wearing tight clothing in the weeks after their procedure.