Surgery has been the most frequently used intervention in BPH for many decades. However, since the late 1980s there has been a marked decrease in the number of surgical procedures undertaken in Europe and the USA.71-74 This decline corresponds with the introduction of new, less invasive treatments that are associated with fewer complications. Despite this, surgery remains an appropriate therapy for some patients, e.g. those with LUTS refractory to drug treatment or with BPH-related complications.
Surgical options for BPH are TURP, transurethral incision of the prostate (TUIP) and open prostatectomy. TURP is the most commonly performed surgical procedure. It is indicated in patients with small to moderately enlarged prostate glands (£80cc), and takes less than 90 minutes to complete. TUIP is an alternative surgical procedure to TURP for men with small prostates (<30cc). Open prostatectomy is indicated in men with greatly enlarged prostates (80-100cc), and is also the surgical treatment of choice for men with bladder damage or complications that prohibit TURP.
Transurethral resection of the prostate
TURP involves the urethral insertion of a resectoscope, which has an electrical loop and valves for controlling irrigating fluids. The electrical loop removes the obstructing tissue, which is carried to the bladder by the irrigating fluids. TURP results in symptom improvement in many men, and an improvement in objective measures such as peak urinary flow rate. However, the complications that have been attributed to TURP include retrograde ejaculation, impotence and some degree of urinary incontinence.75
Transurethral incision of the prostate
TUIP involves the surgeon making one or more incisions in the neck of the bladder at the junction with the urethra, extending into the prostate. This reduces the prostate's pressure on the urethra and makes urination easier. It is an effective procedure, with minimal adverse effects, including a lower incidence of retrograde ejaculation than TURP. However, there are restrictions on the size of prostate that can be treated using this technique (<30cc), and hence it is used less frequently than TURP.
Open prostatectomy
Open prostatectomy is the oldest form of prostate surgery. An external incision is made in the lower abdomen or in the perineum, and the prostate is removed. The invasiveness of this technique means that it is the surgical treatment with the highest complication rate.