Prostate surgery

Prostatectomy is a prostate surgery procedure. Unlike “radical” prostatectomy for cancer, where the entire prostate is removed, only the inner part of the prostate is removed in men with BPH (enlarged prostate). This is usually accomplished by passing an instrument, under anaesthesia, through the urethra and coring out the prostate. This is called a transurethral resection of prostate (TURP) and is the most common operation done for the management of symptoms related to BPH.

Some urologists use a laser to perform this type of prostate surgery. Less frequently, when the prostate is very large, open prostatectomy is required. In this case, the inner prostate tissue is removed through an incision in the lower abdomen.

There are some potential side effects as well as benefits related to prostate surgery, however, the risks are small and the vast majority of men will experience marked improvement in urination. A few patients continue to experience some symptoms that may respond to drug therapy.

Men are often concerned about the effect of TURP on their sexual function. The majority of men will notice loss of ejaculation. This is due to the semen flowing backwards into the bladder and is called retrograde ejaculation. While this means that you are unable to father a child, it does not interfere with the ability to have and enjoy normal sexual activity. Occasionally, patients have difficulty obtaining erections (impotence) after TURP, as they can after any operation, usually for psychological reasons. Patients who are potent prior to TURP are usually potent afterwards.

Temporary incontinence may occur in some patients but permanent incontinence is rare. The majority of men will have no further problems with BPH (enlarged prostate) after their TURP prostate surgery. However, between 10% to 15% of patients may require a repeat TURP within the following 10 years.

Transurethral Incision of the Prostate (TUIP)
Instead of coring out the prostate, a similar instrument is used to make an incision inside the prostate. For men whose prostate is only slightly enlarged, this improves urination as effectively as TURP but is a smaller procedure with minimal complications.

Transurethral Microwave Thermotherapy (TUMT)
This procedure, which may not be available in all countries, is performed without anaesthesia as an outpatient. A special catheter is inserted into the urethra. Microwaves are used to heat and destroy tissue inside the prostate which results in improved urination. Complications are minimal. Need for re-treatment is higher than following surgery.

Transurethral Needle Ablation of the prostate (TUNA)
This prostate surgery procedure, which is not widely available in many countries, is performed with or without anaesthesia as an outpatient. A special needle is repeatedly inserted into the center of the prostate with a specialized cystoscope and radiofrequency waves are used to heat and destroy prostate tissue. Complications are minimal and the results, which may be slightly better than medical therapy are not as good as those experienced by men who have undergone TURP.

Which option should I choose?
Many patients with mild to moderate symptoms of BPH (enlarged prostate) do not require treatment and will be managed by “watchful waiting”. The decision regarding treatment will depend upon a variety of factors such as severity and rate of progression of your symptoms, age, general health, prostate size, PSA and current availability of some of these treatment options as well as your own preferences. The advantages and disadvantages and availability of these options should be discussed with your doctor.

Reprinted from
An Educational Service of The Canadian Prostate Health Council

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