There are several different approaches to prostate surgery and they can be done in a variety of ways.
Your surgery may be performed endoscopically (i.e. through your urethra), or by an open approach. There are several types of surgery available, each with its own benefits.
Transurethral resection of the prostate (TURP)
Your surgeon uses an instrument to access your prostate via your urethra. They then remove part of the prostate gland. This can reduce pressure on your urethra and improve the flow of urine. There are no visible scars following surgery.
If your prostate is very large, your surgeon may recommend an open ‘simple’ prostatectomy (as opposed to an open ‘radical’ prostatectomy, which is a different procedure performed for prostate cancer). With an open prostatectomy, your surgeon makes a 10cm incision in your abdomen, then removes out part of your prostate.
Less invasive procedures
There are a number of newer, less invasive procedures for treating enlarged prostate. Some can be performed under local anaesthetic with sedation.
Transurethral incision of the prostate (TUIP)
This day procedure can relieve urinary problems caused by benign prostate enlargement. Your surgeon uses an instrument to access your prostate via your urethra. The instrument uses an electric current to cut through the muscle where your prostate meets your bladder. This relaxes the opening to your bladder, so that urine can flow more freely. No tissue is removed. If your prostate is only slightly enlarged, this may be a good option. It reduces symptoms in 8 out of 10 men. TUIP is not the same as TURP (above).
This type of therapy is similar to TUIP but it uses a laser probe inserted through your urethra to vaporise some of your prostate tissue and relieve pressure on your urethra. It’s normally done as a day procedure. It’s as effective as TURP with fewer side effects and less downtime. There are different types of laser including GreenLight™ laser, holmium laser and thulium laser. If you’re interested in laser prostate surgery, you need to find a urologist who offers one of these procedures. Laser therapy may be a good option if you’re taking anticoagulant medication.
Some types of laser therapy are covered by Medicare. Check with your doctor to make sure you’ll be covered.
This procedure uses tiny implants to lift your enlarged prostate out of the way of your urethra. Your doctor accesses your prostate through your urethra. No tissue is cut, heated or destroyed and it can be done as a day procedure using local anaesthesia. It has the same types of adverse effects as other procedures except that it virtually eliminates the risk of sexual side effects.
Urolift® may not be practical if your prostate is very large. As this is a relatively new procedure, there’s limited information about its long-term effectiveness and safety and it isn’t covered by Medicare.
Prostate artery embolisation
An interventional radiologist injects the arteries feeding your prostate with minute beads. They stay in place and reduce the blood supply to your prostate which can make it shrink. It’s a day procedure performed with sedation and local anaesthesia. The treatment is still considered experimental. It’s not currently covered by Medicare and can’t be claimed on your health insurance.
Which is the best type of surgery?
The best method for you will depend on factors such as the size of your prostate, your general health, previous surgeries, whether you’re taking blood thinners, the experience of your surgeon and your personal preference.