Enlarged Prostate surgery, typically for benign prostatic hyperplasia (BPH) and sometimes prostate cancer, involves removing or reducing excess prostate tissue to alleviate urinary symptoms. Common procedures like TURP or laser surgery are minimally invasive, resulting in improved urinary function and quality of life.

Introduction

Enlarged prostate, or also known as benign prostatic hyperplasia (BPH)^[1] is a common condition in older men over the age of 50. It is usually a common cause of lower urinary tract symptoms and the risk of developing BPH rises as men increase in age. BPH occurs when there is an overgrowth in cell tissue in the prostate which leads to urinary difficulties.

Other than age being a huge risk factor, other ones include genetics, obesity and having metabolic syndrome^[2] (combination of high blood pressure, diabetes or insulin resistance, and high cholesterol). Signs of enlarged prostate include urinating often at night (nocturia), weak stream, not being able to fully empty bladder and dribbling at the end of urination. Complications often lead to urinary retention, urinary tract infections (UTI) especially recurrent ones and blood in urine (hematuria). Treatment for enlarged prostate includes observation, medical therapy or surgical interventions in order to help provide relief for those affected by BPH.

Enlarged prostate surgery, medically termed as transurethral resection of the prostate (TURP), is a critical procedure designed to alleviate the symptoms associated with benign prostatic hyperplasia (BPH). BPH is a common condition in aging men, characterized by the enlargement of the prostate gland, which can lead to urinary difficulties. This surgical intervention involves the removal of excess prostate tissue, thereby restoring normal urinary function and improving the patient’s quality of life. In this concise overview, we will delve into the key aspects of enlarged prostate surgery, its indications, surgical techniques, and potential benefits, highlighting its role in providing relief and enhanced well-being for those affected by BPH.

What is Enlarged Prostate Surgery?

Enlarged prostate surgery is a specific surgical procedure aimed at treating BPH. There are multiple types of surgeries but what they have in common is they remove excess prostate tissue that obstructs the urethra which causes the unwanted urinary symptoms. Some surgeries are more conservative and do not require too much cutting away at the prostate while others may need more of the organ excised. Benefits of enlarged prostate surgery usually will include improved urinary flow, reduced urgency and frequency of urination and overall relief from other BPH-related symptoms. Usually surgery is considered when traditional medical options such as taking medications or lifestyle changes fail to adequately relieve symptoms or worsens the condition especially if there are recurrent infections or bladder stones. The overall best determination if surgery is needed is if prostate size is increasing as symptoms tend to get worse as volume goes up.

One standard surgical technique that is used is called transurethral resection of the prostate (TURP) which is one of the common methods and minimally invasive as well. However there are other enlarged prostate^[3] surgeries that may be warranted based on how severe or large the prostate is in the individual. Usually providers will be able to determine the best approach to treat BPH.

What are the different types of Prostate Surgery?

Enlarged prostate surgery encompasses a large variety of procedures designed to address different prostate-related conditions, with the most common being for BPH and prostate cancer. These surgeries can range from minimally invasive to open and more complex procedures.

• Transurethral resection of the prostate (TURP): TURP is the standard surgical treatment for BPH. A thin tube (resectoscope) is inserted into the urethra and guided through to the prostate. The resectoscope has a tiny camera and an electrical loop that is used to mechanically remove the prostate tissue and since it contains heat it is also able to seal off vessels.
• Holmium laser enucleation of the prostate (HoLEP): This procedure uses a laser to remove large portions of the prostate that are blocking urine flow and will also prevent regrowth of the tissue. This is another minimally invasive surgical option for treating BPH.
• Simple/open prostatectomy: This procedure involves removing large parts of the prostate through the lower abdomen. This surgery will be reserved for those who cannot undergo less invasive surgeries and for more complex cases.
• Transurethral incision of the prostate (TUIP): This procedure involves making one or two small incisions in the prostate gland using a scope which is inserted through the urethra. TUIP is minimally invasive and it relieves pressure of the urethra which improves urine flow. This process is used more for small to moderately sized enlarged prostate.
• UroLift procedure: This procedure utilizes a camera to move the prostate from the urethra and small implant devices or probes hold the prostate in place to prevent urine flow blockage and other urinary symptoms.

The choice of which prostate surgery will depend on the specific condition, its severity, and the individual’s health. Each procedure has its own set of advantages, risks, and recovery times and patients should consult with a urologist to determine the best surgical option.

What to Expect during Prostate Surgery?

Prostate surgery overall, whether for BPH or prostate cancer, has certain expectations and steps that can vary depending on the type of surgery. The main reason it makes a difference in expectations is because some surgeries will require either local anesthesia (numbing the area during the procedure) or general anesthesia (being in a sleep-state during surgery) thus the surgery type will affect how the individual should prepare before surgery.

Local anesthesia usually does not require too much preparation before or during surgery however, for general anesthesia there is some readiness needed on the patient before surgery. Fasting the night before, quitting smoking about six weeks prior to surgery and avoiding alcohol 48 hours before surgery are the main preparations that are needed before general anesthesia.

However, certain medications, vitamins and supplements, especially if taking blood thinners, may need to be stopped before surgery to prevent complications that may arise during the procedure or may prevent the anesthesia from working. In addition if suffering from specific conditions, such as sleep apnea, this may have its own separate list of expectations and requirements, as this can cause issues for the patient during surgery. Therefore it is critical to meet with surgeon or healthcare staff in order to understand the expectations and ask any additional questions prior to the procedure.

What Do you Expect after Prostate Surgery?

There are quite a few expectations when undergoing enlarged prostate surgery especially after the procedure is completed. If undergoing the most common surgery, TURP, or other invasive or noninvasive surgeries, there is typically a recovery period of about one to three days in the hospital before going home. There might also be fluids given directly in the vein until after the anesthetic leaves the body and normal eating and drinking can resume.

Since the urethra will be swollen, a catheter will be used instead to flush out the bladder and will be taken out once urination can be done normally again. If not, the catheter will stay in and can be taken home if needed. There will probably be some discomfort and bladder spasms mainly from the catheter that will be put in place but not severe pain. Usually for the first 3-4 weeks, you might feel tired and it might be hard to move around at first therefore, it’s important to keep rested and not engage in any strenuous activities. After enlarged prostate surgery it is normal to see blood in urine, however, if blood clots form or bleeding worsens the doctor will have to be contacted to further evaluate. Also urinary symptoms such as, sense of urgency or frequency and painful urination might occur but will disappear as you continue to heal.

Recovering from Prostate Surgery

Recovering from enlarged prostate surgery, whether it be for BPH or prostate cancer, will need patience and following post operative instructions for weeks or even for months after. Recovery times vary depending on the type of surgery and individual factors. It’s essential to follow your healthcare team’s guidance closely. Most individuals experience significant improvements in their urinary symptoms and overall quality of life following surgery, however, to get back to normalcy after surgery it will take time. Typically the time it takes to recover will be about 3 to 4 weeks but can even be up to 6 weeks.

Recovery will need to include the following:

• Drinking plenty of water. This will help flush out the bladder.
• Eating high-fiber foods. To avoid constipation and straining during bowel movements.
• Waiting to resume taking certain medications. Medicine such as blood thinners will have to wait until the doctor clears the patient to start taking again in order to prevent bleeding.
• Avoiding strenuous activity. Exercises such as heavy lifting and other intense workouts will have to wait till the doctor gives the clearance to resume these activities.
• Keeping up with wound and catheter care. Mainly ensuring that both the surgical area and catheter is clean and dry.
• Holding off on sexual activities.
• Avoiding driving until the catheter is taken out.

What are some Treatments for Prostate Enlargement with Surgery?

Surgery is mainly a highly effective treatment option, especially when conservative measures like medications have proven insufficient. However, with surgery there might be other medications that will be required of the individual to take and supplements that can be added on to ease the effects of symptoms. As far as treatment with surgeries, TURP is the most commonly used as this is noninvasive and no external scars are typically seen with this method.

When it comes to using medications to treat enlarged prostate, there are several different types.

• Alpha blockers (tamsulosin, alfuzosin) relaxes muscles in the prostate gland making it easier to urinate.
• Anticholinergics (oxybutynin) relax the bladder muscles.
• 5-alpha reductase inhibitors (finasteride, dutasteride) help shrink enlarged prostate glands and are the most commonly prescribed.

Supplements may also help to ease urinary symptoms in regards to prostate enlargement. Prostara is a natural supplement used to reduce swelling and urinary tract symptoms associated with the prostate. Prostara prostate supplement also helps improve sexual function as well as boosts the immune system. Incorporating Prostara can be beneficial if suffering from prostate issues.

Conclusion

Surgery for an enlarged prostate, whether due to BPH or prostate cancer, is a valuable treatment option that can significantly improve a patient’s quality of life. While it may not provide a complete cure, it can effectively address bothersome urinary symptoms, restore normal urinary function, and, sometimes in cancer, can be curative. The decision to undergo prostate surgery should be made in consultation with a healthcare provider, considering the severity of the condition, its impact on daily life, and individual health factors. With advancements in surgical techniques like minimally invasive procedures and innovative technologies, as well as supplements such as Prostara, recovery times are often shorter, making this a viable and positive choice for many.

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