What are the Office-Based Procedures and Hospital-Based Surgical Treatment Options for BPH and Enlarged Prostate?

by Alex Shteynshlyuger MD

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First I should note that the diagnosis of BPH is typically based on symptoms such as poor urine flow, need to wake up at night frequently to urinate, frequent urinary tract infections or UTIs, bladder stones, blood in urine and renal insufficiency which is poorly functioning kidneys as a result of BPH.  The choice of treatment really depends on patient symptoms and the patient’s preferences.

TURP or Greenlight Laser

Treatment for BPH

Once medications stop working or if the patient finds medical treatment for BPH unacceptable, there are 5 options.

Three of the options are office procedures – that utilize Microwave or TUNA (transurethral needle ablation of the prostate) technologies; or Urolift system for BPH.

Two of the options are usually hospital or Ambulatory Surgery Center technologies:  Laser technology-based procedures (Greenlight, Holmium as well as other lasers) and transurethral resection of the prostate (TURP).


Let’s review Treatment Options for Enlarged Prostate

Option #1: Transurethral Resection of the Prostate (TURP) – traditional ‘rotor-rooter” procedure where the urologists resect the prostatic tissue using electrocautery. TURP traditionally has more short-term side effects and risks than other options.  There are more modern approaches using Bipolar TUPR for example PlasmaButton that avoid some of the side effects of TURP such as hyponatremia, or TUR ablation of the prostate. The major advantage of TURP is that one can obtain prostate tissue samples for a pathologist to review. This is important for some patients. TURP is usually done in the operating room in the hospital or Ambulatory Surgery Center. Most men go home the same or next day.

Option #2: Laser Ablation of the Prostate. There are a variety of prostate lasers available with names such as PVP, Greenlight laser, Holmium Laser, Revolix laser and a number of others.  All of them have similar efficacy to TURP, typically with fewer short-term side effects. Most men go home the same day. Laser procedures on the prostate are usually done in the operating room in the hospital or ambulatory surgery center; some can be performed in the office settings.

Option #3: Transurethral Microwave Thermotherapy also called TUMT, Targis™, and Prolieve™.  These are office procedures that take 30-45 minutes to perform.  Most men go home without a catheter; some men require temporary or intermittent catheterization.

Option #4: Transurethral Needle Ablation of the Prostate called TUNA also known commercially as Prostiva™. These are office procedures that take 30-45 minutes to perform.  Most men go home without a catheter; some men require temporary or intermittent catheterization. The efficacy and side effect profile is very similar to TUMT (Option #3).

Some men may need a catheter for a short period of time from a few days to a few weeks. Microwave and TUNA treatments have fewer side effects than TURP, in particular, the risk of retrograde ejaculation is much lower with Prostiva than with TURP; it is also lower with TUMT than with TURP.  About 30% of men will need another treatment within 5 years; in comparison, few men need retreatment after Laser or TURP procedures within 5 years of surgery.

 Option #5: Urolift for Enlarged Prostate.  This is an office procedure that can be done under local anesthesia or under light sedation in a hospital or surgical center. You can expect to go home the same day. This procedure is very effective for improving symptoms in men with an enlarged prostate who do not have a median lobe enlargement. The major benefit of this treatment is the lack of any sexual side effects with minimal risk of retrograde ejaculation.

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