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Guidelines for sites linking to mayoclinic.orgMayo Clinic offers a variety of surgical treatment options, including minimally invasive therapies and traditional open surgery.
With the exception of some laser procedures, minimally invasive therapies are slower to produce results than conventional surgical procedures, because it can take time for the dead prostate tissue to be broken down and reabsorbed naturally. Men who are not troubled by severe BPH symptoms are often willing to accept this trade-off to avoid hospitalization and the chance of more serious complications.
Minimally invasive therapies tend to produce similar side effects to one another, including some degree of prostate gland swelling, irritation, and an urgency to urinate. These problems can be managed by occasional use of a urinary catheter or medications for up to several days following the procedure.
Major complications are uncommon for any of the following minimally invasive therapies, and problems such as impotence (erectile dysfunction) and incontinence are very rare.
Surgeons perform high-energy laser therapy, a form of heat therapy which vaporizes overgrown prostate tissue, to provide swift symptom relief. Laser therapy generally doesn't cause impotence or prolonged incontinence. However, some laser procedures require use of a catheter for up to several days while the prostate heals and swelling subsides.
Mayo Clinic urologists pioneered the development of laser therapy for the prostate and led many initial clinical trials. Mayo surgeons use several laser therapies for treating BPH, including holmium laser enucleation, laser photoselective vaporization, and older technologies such as transurethral evaporation and visual laser ablation.
Holmium laser enucleation of the prostate (HoLEP) may be used in cases where the prostate is dramatically enlarged, although the procedure can be performed for most instances of BPH regardless of prostate size. The holmium laser procedure provides nearly immediate symptom relief and doesn't penetrate tissue deeply, allowing urologists to carefully enucleate overgrown tissue. HoLEP completely removes all obstructing prostate tissue down to the prostate's encapsulating structure.
HoLEP is a permanent BPH treatment that features all the benefits of open surgery to remove obstructive prostate tissue but decreases some of the potential complications, such as bleeding and urinary incontinence.
In addition, HoLEP allows surgeons to obtain BPH tissue during the procedure for microscopic examination to ensure no prostate cancer is present. Cancer is found in about 10 percent of HoLEP procedures, even in patients previously screened for prostate cancer.
HoLEP is an innovative technique that's widely acknowledged as a benchmark BPH procedure, but is not available everywhere in the United States because it requires specialized skills and training. Mayo Clinic is one of only a few medical centers in the U.S. that performs HoLEP procedures. HoLEP is typically performed under general anesthesia and patients generally go home the next day with no need for a catheter.
Illustration of prostate surgery using laser PVP
Mayo Clinic pioneered the development, research and propagation of laser photoselective vaporization of the prostate (PVP) for treating BPH. Mayo Clinic developed the technique in 1997, adapting a potassium-titanyl-phosphate (KTP) laser system for prostate surgery. Mayo surgeons are extremely proficient with laser PVP, performing about 300 such procedures annually.
Laser PVP has emerged as a safe, less invasive and effective alternative to transurethral resection of the prostate (TURP) (see description below), the long-standing BPH treatment of choice. Laser PVP has gained worldwide recognition since it came into standard use at Mayo Clinic in 2003, and has become a common surgical treatment for obstructive BPH. A variety of ablative lasers are available, including holmium, KTP, diode and thulium laser treatments. Each of the lasers uses a unique wavelength that treats the prostate in a different way; for example, some lasers penetrate prostate tissue deeper than others.
Transurethral evaporation of the prostate (TUEP) and visual laser ablation of the prostate (VLAP) both use laser therapy to destroy prostate tissue. Patients often experience a noticeable improvement in urine flow. TUEP and VLAP have largely been replaced by more modern procedures such as PVP, HoLEP and TURP.
Microwave thermal therapy, also known as transurethral microwave thermotherapy (TUMT), is an outpatient procedure that takes about one hour. With the aid of a urinary catheter, a surgeon inserts a tiny antenna-like wire into the urethra. The antenna delivers microwave energy to heat and destroy the overgrown tissues while avoiding damage to normal tissues. The procedure does not require anesthesia, but sedatives are given to minimize pain and discomfort. TUMT is best suited for relatively small prostates exhibiting minimal BPH symptoms.
Mayo Clinic urologists published the only randomized, double-blind clinical trial of microwave thermal therapy, which found the procedure to be safe and effective compared to a placebo procedure. See PubMed reference.
Mayo Clinic urologists use one of two techniques that rely on needle ablation therapy to destroy overgrown prostate tissue.
PROSTIVA radiofrequency (RF) ablation — formerly known as transurethral needle ablation (TUNA) — uses radiofrequency energy to heat and destroy enlarged prostate tissue. Unlike microwave thermal therapy, PROSTIVA RF requires some anesthesia — either pelvic blocks, a spinal anesthetic, or a general anesthetic. PROSTIVA RF is an outpatient procedure usually performed in a hospital setting and can be used to target sections of the gland that may not be accessible to a microwave antenna. For example, if an overgrown lobe protrudes into the bladder opening, the radiofrequency needles can be placed in that area to destroy the overgrown tissue.
During indigo laser therapy, a surgeon delivers laser energy through a needle. This minimally invasive BPH treatment is done in the outpatient surgery department with the patient under sedation or light anesthesia. The laser destroys prostate cells deep in the gland, which are sloughed off during healing. Because the central urethra is not affected, significant bleeding rarely occurs. Indigo laser needle therapy has largely been replaced by newer techniques and technology.
TURP has been the standard surgical BPH treatment for many years. TURP remains a very effective treatment for patients who retain urine and have moderate to severe symptoms. During a TURP procedure, a surgeon threads a narrow instrument (resectoscope) into the urethra and uses small cutting tools to scrape away excess prostate tissue using electrical energy. Patients can expect to stay in the hospital for one to three days after surgery.
In some cases of extreme prostate enlargement for which some minimally-invasive procedures would be ineffective, open surgery (superpubic prostate resection) is necessary to remove the swollen tissue. The procedure is also used in cases where the bladder is damaged, when bladder stones are present or when the patient has urethral strictures.
The surgeon makes an incision in the lower abdomen to reach the prostate. During the procedure, the inner portion of the prostate is removed while the outer, encapsulating portion remains intact. Patients are often hospitalized for five to seven days and require catheterization. Open prostate resection is becoming increasingly uncommon, because more minimally invasive procedures, such as HoLEP, can deliver the same results with less risks, hospitalization, and blood loss.
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