Enlarged Prostate: Should I Have Surgery?

Home treatment

Home treatment won't stop your prostate from getting larger. But it can help your symptoms. Try these home treatment tips:

• Practice "double voiding." Urinate as much as you can. Then relax for a few moments and try to go again.
• Avoid caffeine and alcohol. They make your body try to get rid of water and can make you urinate more often.
• Try to avoid medicines that can make it hard to urinate. These include over-the-counter antihistamines, decongestants (including nasal sprays), and allergy pills. Check with your doctor or pharmacist about your medicines.

Medicine

If home treatment doesn't help, you can take medicine for an enlarged prostate. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.

Surgery

If your symptoms are very bad, your doctor may suggest surgery to remove part of your prostate. Few men have symptoms or other problems that are this bad.

The most common surgery is TURP (transurethral resection of the prostate). A thin tool is inserted up the urethra to remove the section of prostate tissue that is blocking urine flow.

Other types of surgery include:

• Plasma vaporization ("button" procedure), which removes prostate tissue.
• Laser therapies, which remove a portion of the prostate.
• Transurethral incision of the prostate (TUIP). During this procedure, incisions are made in the prostate to reduce pressure on the urethra.
• A less invasive surgery may be an option for some men who have an enlarged prostate. These methods appear to reduce symptoms of an enlarged prostate. But they don't seem to have the side effects that are common with other surgeries, such as erection problems. Examples include:
  • Prostatic urethral lift (such as Urolift). For this surgery, a device is placed to compress the prostate tissue and improve urine flow.
  • Convective radiofrequency (RF) water vapor thermal therapy (such as Rezum). During this surgery, hot water vapor is used to destroy prostate tissue and improve urine flow.

There are also some other surgeries. Talk to your doctor about these options.

The American Urological Association (AUA) symptom index helps you describe how bad your symptoms are. This index can also be used to measure how well various treatments might work for your symptoms. But the most important thing is how much the symptoms bother you.

TURP

Symptoms get better for more than 70 out of 100 men who have this surgery.^{footnote 1}

Men who are very bothered by their symptoms are most likely to notice great improvement. Men who are not very bothered by their symptoms are less likely to notice a big change.

TURP has possible side effects, such as:

• Retrograde ejaculation. This means that semen flows backward into the bladder instead of out through the penis. It isn't harmful, but it can affect your ability to father children.
  • Out of 100 men who have TURP, 25 to 99 have retrograde ejaculation. That means 1 to 75 out of 100 men do not.^{footnote 1}
• Erection problems.
  • Out of 100 men who have TURP, 3 to 35 report having erection problems. That means 65 to 97 out of 100 men do not.^{footnote 1}
• Incontinence. A small number of men say they are unable to hold back their urine after surgery.
  • Out of 100 men who have TURP, about 1 reports not being able to control urine flow. That means about 99 out of 100 men are able to control urine flow.^{footnote 1}

A few men will need a second operation several years later, because their symptoms return. This can happen for many reasons, such as if:

• The surgery doesn't remove enough of the prostate.
• The prostate continues to enlarge after surgery.
• Scar tissue from the surgery blocks the urethra.

Your doctor may recommend surgery if:

• You cannot urinate.
• You have a partial blockage in your urethra that is causing repeated urinary tract infections, bladder stones, or bladder damage.
• You have kidney damage.
• Medicines have not helped.
• You have too many side effects from the medicines.