Surgery for BPH
An enlarged prostate can cause bothersome symptoms for men including reduced flow, incomplete bladder emptying, having to go more often or dribbling. Medical management can be effective as an initial management, but surgical management may need to be considered if medication is not tolerated or hasn’t worked.
There are several surgical options for managing an enlarged prostate (benign prostatic hyperplasia or BPH). Here are the main options, along with their indications, pros, cons, and ideal patient profiles:
Indications:
- Moderate to severe urinary symptoms not responding to medication
- Recurrent urinary tract infections
- Bladder stones
- Kidney damage
Pros:
- Very effective at reducing symptoms
- Immediate improvement in urine flow
- Long-lasting results
Cons:
- Risk of bleeding
- Potential for retrograde ejaculation
- Short hospital stay required
- Risk of urinary incontinence (usually temporary)
Ideal patient:
- Men with moderate to large prostate enlargement
- Those who have failed medical therapy
- Patients who can tolerate general anesthesia
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Indications:
- Similar to TURP, for moderate to severe symptoms
Pros:
- Lower risk of bleeding compared to TURP
- Shorter hospital stay
- Quicker recovery
- Can be used for very large prostates (especially HoLEP)
Cons:
- May require specialized equipment and training
- Potential for temporary urinary symptoms post-surgery
Ideal patient:
- Men on blood thinners or with bleeding disorders
- Those with very large prostates (HoLEP)
- Patients seeking a quicker recovery
Indications:
- Mild to moderate symptoms
- Smaller prostates
Pros:
- Lower risk of retrograde ejaculation compared to TURP
- Shorter procedure time
- Can be done under local anesthesia
Cons:
- Less effective for larger prostates
- May need to be repeated
Ideal patient:
- Men with smaller prostates (less than 30g)
- Those concerned about preserving ejaculatory function
Indications:
- Moderate symptoms
- Prostates less than 80g
Pros:
- Minimally invasive
- Preserves sexual function
- Can be done under local anesthesia
- Quick recovery
Cons:
- Less effective than TURP for symptom relief
- May not be suitable for very large prostates
Ideal patient:
- Men concerned about sexual side effects
- Those seeking a minimally invasive option
- Patients with prostates under 80g
Indications:
- Moderate symptoms
- Prostates 30-80g
Pros:
- Minimally invasive
- Preserves sexual function
- Can be done in an office setting
Cons:
- May take several weeks to see full benefit
- Less effective than TURP for very large prostates
Ideal patient:
- Men seeking to preserve sexual function
- Those preferring an office-based procedure
- Patients with prostates 30-80g
Indications:
- Moderate symptoms
- Prostates 30-80g
Indications:
- Moderate to severe symptoms
- Larger prostates
Pros:
- Precise tissue removal
- Potentially lower risk of sexual side effects
- Suitable for large prostates
Cons:
- Requires general anesthesia
- Limited long-term data
Ideal patient:
- Men with larger prostates
- Those concerned about precision and sexual side effects
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Indications:
- Very large prostates
- Complications like bladder diverticula
Pros:
- Effective for very large prostates
- Can address complex cases
Cons:
- More invasive
- Longer recovery time
- Higher risk of complications
Ideal patient:
- Men with extremely large prostates (>80-100g)
- Those with concurrent bladder issues needing repair
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