Surgical Procedures for Benign Prostatic Hyperplasia (BPH) Cure

Recommended Surgical Options

The American Urological Association recommends Transurethral Resection of the Prostate (TURP) as the gold standard surgical treatment that physically removes obstructing prostatic tissue 1
Open Prostatectomy is recommended for very large prostates and remains one of the most effective procedures for complete removal of prostatic tissue 2
Transurethral Electrovaporization uses electrical current to vaporize prostatic tissue 2
Transurethral Holmium Laser Resection/Enucleation provides complete removal of obstructing tissue with potentially fewer bleeding complications 2
Transurethral Laser Vaporization uses laser energy to vaporize prostatic tissue 2
Transurethral Laser Coagulation is also known as visual laser ablation of the prostate 2

Surgery is specifically recommended for patients with refractory urinary retention who have failed at least one attempt at catheter removal 3
Surgery is recommended for patients with renal insufficiency clearly due to BPH 3
Surgery is recommended for patients with recurrent urinary tract infections (UTIs) due to BPH 4
Surgery is recommended for patients with recurrent gross hematuria due to BPH 4
Surgery is recommended for patients with bladder stones clearly due to BPH and refractory to other therapies 4

Transurethral Microwave Thermotherapy (TUMT) uses microwave energy to heat and destroy excess prostate tissue 1
Transurethral Needle Ablation (TUNA) is more effective than medical therapy but less effective than TURP 1

Balloon Dilation is not recommended as a treatment option for BPH due to inadequate study results and significant failure rates over time 3
High-Intensity Focused Ultrasound and Absolute Ethanol Injection are considered investigational and should not be offered outside clinical trials 3
Prostatic Artery Embolization (PAE) is not recommended outside clinical trials according to the American Urological Association 5

Surgical complications may include sexual dysfunction, bladder neck contracture, need for blood transfusion, UTI, and hematuria 1

Urethrocystoscopy is appropriate in patients with a history of microscopic or gross hematuria to rule out other pathology, as recommended by the American Urological Association 6, 7
Pressure-flow urodynamic studies should be considered in patients with Qmax >10 ml/sec when surgery is being considered, as higher flow rates suggest less obstruction and lower likelihood of benefit from surgery, according to the American Urological Association 6, 7
Prostate size assessment via ultrasound helps guide surgical approach, with the European Association of Urology suggesting TURP vs. TUIP for prostates <30g, or open prostatectomy for very large prostates 7

Complications occur in >5% of patients and include sexual dysfunction, irritative voiding symptoms, bladder neck contracture, need for blood transfusion, UTI, and hematuria, as reported by the American Urological Association 8
Risk of urinary incontinence is approximately 1%, according to the American Urological Association 8
TURP syndrome (dilutional hyponatremia from irrigant absorption) is a unique complication, though bipolar TURP has reduced this risk compared to monopolar TURP, as noted by the European Association of Urology 8