Most patients with urinary outflow obstruction begin treatment with medications. Surgical procedures are usually a second option when the condition is far advanced, urgent, or has not responded adequately to medicine.

Emergency Treatment

If the bladder is completely obstructed and you are unable to pass any urine at all, you must be treated immediately. The treatment is to place a tube into the bladder and drain out the urine. The tube may be left in place until the passageway can be more permanently opened. The bladder can be drained with either of these procedures:

  • Transurethral catheterization—This involves a rubber catheter being slipped past the obstruction to allow urine to drain out.
  • Suprapubic catheterization—This may be done if transurethral catheterization fails. A catheter is inserted through the lower abdomen to drain the bladder. A tube can be installed and left for the time required to open up the obstruction in the natural passage.

Surgery

Surgery is only considered in those patients who have failed durg treatment or who have severe symptoms. Transurethral resection of the prostate (TURP) is the gold standard. Prostate stent or the newly approved laser transurethral ablation technique (Holman and/or KTP green light) is considered in those patients who are unfit for surgery or have failed drug treatment.

Minimally Invasive Interventions

In non-emergency situations when medication has failed, there are many new procedures available to open the channel through the prostate. These procedures are typically done on an out-patient basis. You will have some type of anesthesia, typically a combination of local anesthesia and oral sedation. The procedure may involve threading an instrument into your penis. Depending on the particular device, you will probably feel nothing more than that. Each procedure takes about an hour. There are significant differences between these minimally invasive devices. Talk to your urologist in detail before choosing this as a treatment option.

Stents and tubes —the insertion of a variety of temporary and permanent stents and tubes devised to hold open the urethra. These are most useful in patients who are too ill or weak to tolerate more extensive procedures; this treatment is used rarely in the US at the present time.

The following three procedures use some form of heat to destroy prostate tissue:

Transurethral microwave thermotherapy (TUMT) —uses microwaves emanating from a catheter placed into your bladder to destroy excess prostate tissue

Transurethral needle ablation (TUNA) —uses low levels of radiofrequency energy to burn away portions of the enlarged prostate

Transurethral laser therapy or interstitial laser coagulation (ILC) —uses highly focused laser energy to remove prostate tissue, including the recently approved Holman and/or KTP green light lasers

More Invasive Interventions

Both of these interventions require some type of anesthesia, either regional or general. The procedure involves placing surgical tools through your urethra (the tube in your penis).

Transurethral resection of the prostate (TURP) —This is the traditional standard treatment of BPH. For this procedure, a scope is inserted through the penis. This scope contains a heated wire that removes pieces of prostate. The pieces are sent to a pathologist to be tested for the presence of cancer cells.

Transurethral resection of the prostate (TURP)

Breast self-exam, step 2
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Transurethral incision of the prostate (TUIP) —For this procedure, small cuts are made in the bladder neck to widen the urethra. This is usually done in younger patients with smaller prostates.

Most Invasive Intervention

Prostatectomy —This is major surgery and is done to treat benign disease. This approach is chosen only when the size of the obstructing prostate is too large to safely be treated with TURP. Open prostatectomy for BPH is done either through a retropubic approach or the suprapubic approach, depending on the experience of your urologic surgeon. Open prostatectomy is more invasive than the other procedures, but may produce more durable improvement in voiding symptoms.