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Prostate Problem Guide
An Introduction To Surgical BPH Treatment
Although drug treatment and minor minimally invasive surgery can be the solution for many men suffering from BPH (a swollen or enlarged prostate), for others surgery is necessary and there are currently three main surgical procedures carried out for BPH treatment.
The first is known as a transurethral resection of the prostate (TURP). This is the commonest form of surgery used in BPH treatment and involves the removal of the inner core of the prostate. The procedure is performed under general anesthetic (or using a spinal anesthetic) and a wire cutting loop is inserted through the penis and urethra to remove tissue from the prostate. Patients will normally stay in hospital for one or two days for this procedure and, following surgery, will need to uses a catheter to drain the bladder for two or three days.
In cases where the prostate is not too enlarged a more limited form of surgery known as transurethral incision of the prostate (TUIP) may be used. In this procedure instead of removing tissue from the prostate a series of cuts are made in the prostate to relieve pressure on the urethra. This procedure is again carried out under anesthesia and patients will remain in hospital for between one and three days.
In the case of both TURP and TUIP patients will normally require about two to four weeks for recovery and may experience moderate levels of pain or discomfort following surgery. The most commonly seen side effects of surgery are erection difficulty, which appears in about 3% to 13% of patients, and urinary retention, which appears in about 1% to 21% of patients. Some degree of urgency and frequency of urination will also be seen in most patients.
AAWR: anti-androgen withdrawal response; a decrease in PSA seen upon stopping treatment with an anti-androgen such as Flutamide or Casodex®; this occurs because the anti-androgen has induced a mutation in the androgen receptor (AR) which is allowing the anti-androgen to stimulate rather than inhibit prostate cancer growth.
GLEASON: name of physician who developed the Gleason grading system commonly used to grade prostate cancer.
PLOIDY: a term used to describe the number of sets of chromosomes in a cell.
SGOT: serum glutamic-oxaloacetic transaminase; a liver cell enzyme; elevation of SGOT is seen as an effect of liver cell injury by drugs, alcohol and viruses.
The final form of surgery used today is the open prostatectomy. Carried out under general anesthetic, an incision is made in the lower abdomen to allow the surgeon to gain access to the prostate and the inner core of the prostate is then removed.
Patients will normally remain in hospital for several days and will also be required to use a catheter for a time at home after surgery. Recovery from open surgery typically takes about three to six weeks during which time patients may experience a moderate degree of pain or discomfort. The main side effect of open surgery is incontinence which will be seen in about 6% of patients.
Surgery is an excellent form of BPH treatment and can reduce BPH symptoms considerably for most men. It is not however 100% effective and some symptoms will often remain even after surgery.
One point to remember is that BPH treatment does not act as a treatment for prostate cancer. BPH treatment involving the removal of tissue from the prostate only removes tissue from the inner core of the prostate. Prostate cancer however normally first appears on the outer tissue of the prostate from where it will often spread. It is important therefore that BPH patients continue to have regular checkups and screening for prostate cancer.
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