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Decision Assist

Prostate removal

Introduction

The purpose of this tool is to help you decide whether to have surgery to treat an enlarged prostate, also known as benign prostatic hypertrophy (BPH). When making a decision like this, you must balance:

  • The reasons for doing the procedure
  • The potential health risks, drawbacks, or limitations of the procedure
  • Whether there are alternative procedures that may be more appropriate
  • Cost

This tool is not a substitute for professional medical care and advice. Work with your doctor to help you make this decision. A second opinion from another doctor may be valuable. Surgery always carries risks, and you should be fully informed about the risks and benefits of this type of surgery. You should also be aware that research evidence is often limited, and the risks of surgery may not be completely understood. For this type of surgery, there is usually no exact “right” or “wrong” answer.

Your doctor may make certain recommendations to you. However, the final decision about whether to have the surgery rests with you.

What is the surgery?

The prostate gland is an organ at the base of the bladder in men. The gland produces a milky fluid that mixes with sperm to make semen. The tissues in the prostate gland may need to be surgically removed or destroyed as a way to treat an enlarged prostate (benign prostatic hypertrophy) or prostate cancer.

An enlarged prostate can cause many urination problems. These symptoms are usually not serious, but they can be disruptive and bothersome.

Enlarged prostate gland
Click the icon to see an animation showing enlargement of the prostate gland.

In most cases, you will want to try “watchful waiting” or medication first, before considering surgery.

There are several ways to surgically treat or remove an enlarged prostate. Surgeries that involve a hospital stay include:

  • Transurethral resection of the prostate (TURP) – This is one of the most common procedures for prostate removal. In this method, an instrument is inserted into the penis to reach the prostate gland and remove the gland in pieces. You will remain in the hospital for 1 - 3 days. Your doctor will consider the size of your prostate gland, your health, and what type of surgery you may want.
Normal anatomy

Click the icon to see an illustrated series showing TURP.

  • Open (or simple) prostatectomy – In this method, a cut is made in the lower abdomen between your belly button and penis, through which the prostate gland is removed. This is a much more involved procedure and usually requires a longer hospital stay and recovery period. This method is often recommended for removing very large prostates.

Several newer methods use microwaves or lasers to destroy prostate tissue. These procedures are usually done in your doctor's office or t an outpatient surgery clinic.

Prostate removal surgery can be done in many different ways, depending on the size of your prostrate and what caused it to grow. Your doctor will consider the size of your prostate, how healthy you are, and what type of surgery you may want.

All of these procedures are done by passing an instrument through the opening in your penis. You will be given general (you will be asleep and pain-free), spinal, or epidural anesthesia (you will be awake but pain-free), or local anesthesia and sedation choices are:

  • Laser prostatectomy -- Laser prostatectomy takes about 1 hour. The laser destroys prostate tissue that blocks the opening of the urethra. You will probably go home the same day. You may need a Foley catheter placed in your bladder to help drain urine for a few days after surgery.
  • Transurethral needle ablation (TUNA) -- The surgeon passes needles into the prostate. High-frequency sound waves (ultrasound) heat the needles and prostate tissue. You may need a Foley catheter placed in your bladder to help drain urine after surgery for 3 - 5 days.
  • Transurethral microwave thermotherapy (TUMT) -- TUMT delivers heat using microwave pulses to destroy prostate tissue. Your doctor will insert the microwave antenna through your urethra.
  • Transurethral electrovaporization (TUVP) -- A tool or instrument delivers high-voltage electrical current to destroy prostate tissue. You will have a catheter place in your bladder. It may be removed within hours after the procedure.
  • Transurethral incision (TUIP) -- Your surgeon makes small incisions (cuts) where the prostate meets your bladder. As a result, the urethra becomes wider or more open. This procedure takes 20 - 30 minutes. Many men can go home the same day. Full recovery can take 2 - 3 weeks.

These procedures can usually relieve your symptoms. But you have a higher chance of needing a second surgery in 5 - 10 years than if you have transurethral resection of the prostate (TURP).

The purpose of this decision tool is to help you decide whether to have any type of surgery to treat an enlarged prostate, rather than using watchful waiting or medication.

Key points

  • Surgery may be able to permanently eliminate the symptoms and problems you are having due to an enlarged prostate.
  • These procedures can help up to 90% of the patients undergoing surgical treatment.
  • These procedures are generally safe for most patients.
  • Unfortunately, as with all surgical procedures, there are risks.
  • Not all patients will be helped by the procedures.
  • In a small minority of patients, their urination problems are caused by multiple factors that are not all addressed by the surgery.

How much time this decision tool will take

  • 5 - 10 minutes

What this tool will provide

  • A personalized list of factors for you to weigh
  • Questions to ask your doctor
  • Alternatives to this surgery
  • Recommended reading

Review Date: 4/7/2010
Reviewed By: A.D.A.M. Editorial Team: David Zieve, MD, MHA, and David R. Eltz. Previously reviewed by Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network (11/9/2007).


References:
  • Fitzpatrick JM. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 88.
  • Lourenco T, Pickard R, Vale L, Grant A, Fraser C, MacLennan G, et al. Minimally invasive treatments for benign prostatic enlargement: systematic review of randomised clinical trials. BMJ. 2008 Oct 9;337:a1662.doi:10.1136/bmj.a1662.
  • Abrams P, Chapple C, Khoury S, Roehrborn C, de la Rosette J; International Scientific Committee. Evaluation and treatment of lower urinary tract symptoms in older men. J Urol. 2009;181:1779-1787.
  • Han M, Partin AW. Retropubic and suprapubic open prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 89.
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