Surgical Treatment Options for BPH

by Samuel Eaton, MD

Surgical treatment options for BPH have increased significantly over the past decade. A variety of factors guide choice of surgical modality including patient preference, prostate size, prior surgical interventions, history of urinary retention, anticoagulation therapy, surgeon experience and availability of surgical treatments. 

Transurethral Resection of Prostate (TURP), once considered the gold standard, has decreased in popularity given the development of newer surgical options. During a TURP procedure, the prostate is treated through the urethra and obstructing prostate tissue is cut and removed using a resectoscope. Men will need to temporarily stop or reduce anticoagulant use prior to surgery. TURP may be performed for average and small size prostates. TURP may be performed outpatient or may require an overnight hospital stay for bladder irrigation and hemostasis with approximately 4 percent of patients requiring a blood transfusion. Approximately 60 to 90 percent of men will experience retrograde ejaculation.

A greenlight laser prostatectomy removes obstructing prostate tissue by vaporizing and coagulating prostate tissue using continuous greenlight laser waves. Accessed through the urethra, this is an outpatient procedure ideal for small and average size prostates.

Robotic Assisted Laparoscopic Simple Prostatectomy treats men with extremely large prostate size. This procedure is performed using a laparoscopic approach and with robotic assisted technology. During a robotic simple prostatectomy, the prostate is enucleated, definitely removing any obstructing prostatic tissue. Men will need to temporarily stop or reduce anticoagulant use prior to surgery. Men will spend one night in the hospital and will be discharged home with a urinary catheter to allow the bladder to heal.  The urinary catheter is typically removed in one week in the surgeon’s office at the follow up appointment.

Thulium laser enucleation of the prostate (ThuLEP) uses a high-powered Thulium laser to remove prostate tissue. The technique is more similar to simple prostatectomy in that it removes larger sections of tissue than TURP or Greenlight, but is done without incisions and with shorter catheter time and less bleeding than simple prostatectomy. ThuLEP may be performed on small, average or large size prostates and most patients are sent home the same day.

Unlike other treatments, the UroLift procedure does not remove any prostate tissue. The prostate is treated through the urethra using small implants made of nitinol, stainless steel, and a suture, which lift and compress the prostatic tissue. This creates a wider channel to allow improved urination. UroLift offers very low risk of bleeding or retrograde ejaculation compared to more standard techniques. UroLift is an outpatient procedure and ideal for small to average prostate size.

The iTind is one of the newest treatment options that uses a temporary stent to expand and apply gradual and slow pressure on the prostate to create a wider channel. Similar to UroLift, it works by remodeling the prostate, but without a permanent implant. The temporary stent is removed in the surgeon’s office in 5 to 7 days. This procedure is performed through the urethra and preserves sexual functioning with a very low risk of bleeding. The iTind is an outpatient procedure and ideal for small to average prostate size.