Known as simple prostatectomy, surgery for benign prostatic hyperplasia (BPH) typically involves removing only the prostate tissue that is surrounding and pressing on the urethra. Simple prostatectomy for BPH differs from radical prostatectomy for prostate cancer. In cancer surgery, the surgeon removes the entire prostate and the seminal vesicles (glands located on each side of the bladder that secrete seminal fluid).
More than 90 percent of simple prostatectomies for BPH are performed transurethrally, or via the urethra. Transurethral resection of the prostate (TURP) is the gold standard against which other procedures are measured. About 90 to 95 percent of men with severe symptoms-and 80 percent with moderate symptoms-experience significant improvement, which is a better outcome than treatment with medication or self-help measures.
A simple prostatectomy can also be performed during open surgery. Open surgery requires a single abdominal incision, or, if performed laparoscopically (with or without a robotic-assisted procedure), several small incisions to accommodate the tiny instruments used during the procedure. An open prostatectomy is done when a man’s prostate is so large that a transurethral procedure can’t be safely performed.
Surgery is the fastest, most reliable way to improve BPH symptoms. Fewer than 10 percent of patients will require a repeat procedure five to 10 years later. Compared with other treatment options for BPH, however, surgery is associated with a greater risk of long-term complications, such as erectile dysfunction, incontinence, and retrograde (“dry”) ejaculation. The incidence of these complications varies with the type of surgical procedure.
Now that medications are available to treat BPH, fewer men are opting for surgery. However, when medical therapy fails or when symptoms are severe, surgery may be recommended.