What is Benign Prostatic Hyperplasia (Enlarged Prostate)?

Benign prostatic hyperplasia (BPH) is a noncancerous condition in which the prostate gland becomes enlarged. BPH affects about half of men between the ages of 50 and 60, and approximately 80% of men over 80. As the prostate grows in size, it can press down on the tube where urine flows out of the body (the urethra) and cause urinary problems.

Medication can relieve mild to moderate symptoms of BPH, such as frequent urination, incomplete bladder emptying, a weak urine stream, and straining while urinating. However, other forms of treatment may be more appropriate if you have pain with urination, frequent urinary tract infections, or are unable to urinate. The size of your prostate and the severity of your symptoms will determine the type of treatment you need. If your prostate is not very large, your doctor will likely recommend a transurethral procedure. This minimally invasive technique involves the insertion of a scope into the urethra. The most common transurethral procedures for BPH are:

  • Transurethral incision of the prostate or TUIP, where the surgeon uses the scope to make small cuts in the area of the prostate that meets the bladder. These cuts will open up the pathway for urine and allow it to flow with more ease.
  • Transurethral needle ablation or TUNA, where needles are inserted through the scope and into your prostate. The needles use radiofrequency waves to destroy excess prostate tissue.
  • Laser prostate ablation, where lasers pass through the scope to melt away the part of your prostate causing urine blockage.
  • Transurethral resection of the prostate or TURP, where the inside of your prostate is trimmed and removed one tiny piece at a time using the scope.
If your prostate is too big for a transurethral procedure, you may need a simple prostatectomy, which can be done in one of three ways: laparoscopic, robotic, or open. During a laparoscopic simple prostatectomy, your surgeon makes several small incisions on your belly. Then she inserts a long tube with a camera into one of the cuts and surgical instruments into the others. Using the camera to see inside your belly, she carefully removes the enlarged part of your prostate. Robotic simple prostatectomy uses the same techniques as the laparoscopic method, but the surgery is done with the help of a robot. For men with very large prostates, open simple prostatectomy may be the best treatment option. This surgery differs from the other approaches in that it requires a much larger incision.

Most transurethral treatments for BPH, like TUIP, TUNA, and laser prostate ablation, are done in the doctor's office or outpatient surgery center. TURP and simple prostatectomy, however, need to be performed in the hospital and require an average stay of one to three days. You should wait a week before doing any strenuous activities after a TUIP, TUNA, or laser prostate ablation, and about four to six weeks after a TURP or simple prostatectomy. Although these treatments improve BPH symptoms for most patients, it is important to be aware of the risks involved, such as urine control issues, tightening of the urethra, and erectile dysfunction.