Treatment Options for Enlarged Prostate/BPH
Medical Therapy
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There are several types of medications that can be used to manage the bothersome lower urinary tract symptoms related to benign enlargement of the prostate.
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When medication therapy fails to adequately control symptoms or for those interested in avoiding long-term use of medications, a variety of minimally invasive procedures are available. Nearly all can be performed as a same-day surgery, based on medical fitness of the patient. Procedure selection is based on a combination of prostate size and shape, overall medical condition of the patient, and patient preference.
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Transurethral Resection of the Prostate (TURP)
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Long considered the gold-standard surgical procedure, TURP involves shaving the enlarged prostate tissue growing into the urethra with an electric current delivered through a wire loop ("electrocautery"). The procedure is performed under general or spinal anesthesia. Patients require a urinary catheter (inserted while asleep) for several days after surgery.
UroLift (Prostatic Urethral Lift®)
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Under light or deep sedation, the doctor inserts a camera into the urethra and uses a device to lift and staple the enlarged prostate tissue growing into the urethra to the sides. By doing so, this widens the urethral channel to make urination easier. Therefore, no prostate tissue is being removed in this procedure.
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More information: What is UroLift® and how does it work?
RezÅ«m™ (Water Vapor Therapy)
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Under light or deep sedation, the doctor inserts a camera into the urethra and uses a device to inject water vapor into the prostate. As the water vapor undergoes condensation, it releases energy (in the form of heat) that causes the surrounding prostate cells to die, resulting in retraction of the prostate and opening of the urethra. The procedure takes about 10 -15 minutes to perform and patients return to normal activities within 3 days. Noticeable treatment effects of the procedure can take up to 4-6 weeks for some patients.
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More information: What is RezÅ«m™ and how does it work?
*Both UroLift and Rezum represent modern treatments that are less invasive than the other surgical options listed. While potentially offering lower risks and quicker recovery, they may do so at the expense of lower durability - meaning symptoms could eventually return after treatment. The doctor will provide greater detail on these trade-offs and discuss whether either option is available to the individual patient based on his prostate examination and symptoms.
Aquablation
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Aquablation uses robot-controlled waterjet technology to remove excess prostate tissue in the urethra. The device is administered with the assistance of a camera inserted through the urethra and aided by real-time vision from transrectal ultrasound. The procedure is performed under general anesthesia and requires a catheter for several days after surgery.
Robotic-Assisted Simple Prostatectomy (RASP)
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RASP is a robot-assisted laparoscopic surgery to remove the excess, benign prostate tissue that is obstructing the urethra and causing urinary symptoms. This surgery requires general anesthesia and typically one night in the hospital. It is reserved for very large prostates and perhaps those with concomitant bladder stones who may be otherwise undertreated with less invasive options. Of note, only the central BPH part of the prostate is removed ("simple prostatectomy"), as opposed to the entire prostate gland ("radical prostatectomy").
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