A surgery called TURP (transurethral resection of the prostate) is used for 90% of all surgeries done for an enlarged prostate. In this type of BPH surgery, no external incision is needed. After giving anesthesia, the surgeon reaches the prostate by inserting an instrument down the penis through the urethra. The instrument, called a resectoscope, is about 12 inches long and 1/2 inch in diameter. It contains:
- A light
- Valves for controlling irrigation fluid
- An electrical loop that cuts tissue and seals blood vessels.
During the 90-minute operation, the surgeon uses the resectoscope's wire loop to remove the obstructing prostate tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation.
Most doctors suggest using TURP as BPH surgery whenever possible. Transurethral procedures are less traumatic than open forms of surgery and require a shorter recovery period.
Another BPH surgery is called transurethral incision of the prostate (TUIP). Instead of removing tissue, as is done in a TURP surgery, this BPH surgery widens the urethra by making a few small cuts in the bladder neck (where the urethra joins the bladder) and in the prostate gland itself. Although some people believe that TUIP gives the same relief as TURP with less risk of side effects such as retrograde ejaculation, its advantages and long-term side effects have not been clearly established.
In the few cases when a transurethral procedure cannot be used, open BPH surgery -- which requires an external incision -- may be used. Open surgery is often done when the gland is greatly enlarged, when there are complicating factors, or when the bladder has been damaged and needs to be repaired. The location of the enlargement within the gland and the patient's general health help the surgeon decide which of the three open procedures to use.
In all the open procedures, anesthesia is given and an incision is made. Once the surgeon reaches the prostate capsule, he or she scoops out the enlarged tissue from inside the gland.