Patient education: Surgery for benign prostatic hyperplasia (The Basics)

What is benign prostatic hyperplasia? — The prostate is a gland that surrounds the urethra (the tube that carries urine from the bladder and out through the penis) (figure 1). This gland often gets bigger as a person gets older.

Benign prostatic hyperplasia, or "BPH," is the medical term for an enlarged prostate. BPH is a common problem.

How is BPH treated? — If your symptoms don't bother you very much, you might not need any treatment. But if your symptoms do bother you, your doctor might suggest trying medicines first to see if they help. If medicines don't do enough, surgery is also an option.

Each type of treatment has advantages and disadvantages. Your doctor can help you choose the best treatment plan. This depends on your situation and your preferences.

Are there different kinds of surgery for BPH? — Yes. In some cases, the doctor will do an open surgery to remove part or all of the prostate. But most of the time, doctors do something called a "transurethral" procedure. This involves inserting a thin tube with a tiny camera on the end into the urethra. This is called a "scope." Then, the doctor uses special tools to treat the enlarged prostate (figure 2).

Examples of surgery to treat BPH include:

●Removing parts of the enlarged prostate

●Using energy to destroy some of the prostate tissue or widen the urethra – The energy can come from heat, light, steam, or electricity.

●Inserting a device to move and secure the prostate away from the urethra – This makes a larger opening for the urethra to pass through.

How do I prepare for surgery for BPH? — Some procedures are done in the doctor's office. Others are done in a hospital or surgery center. The doctor or nurse will talk with you about where your procedure will be done and if you need to do anything special to prepare.

Before your procedure, your doctor will do an exam, including a "digital rectal exam." During a digital rectal exam, your doctor will put a gloved finger into your rectum to feel the prostate. They might send you to get tests, such as:

●Prostate-specific antigen ("PSA") and other blood tests

●Urine tests

●Ultrasound – This is an imaging test. It uses sound waves to create pictures of the prostate.

●Special tests to check your bladder function

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk. The doctor might recommend 1 type of procedure over another, based on the medicines you take.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during surgery for BPH? — When it is time for the procedure:

●You might get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will put a small scope into your urethra. This is the opening at the end of your penis. It connects to your prostate and your bladder. The doctor will use special tools to destroy or remove the part of the prostate blocking the urine flow. This removes extra pressure on the urethra and makes a wider area for urine to pass through.

●The doctor will remove the scope. They might place a catheter into your bladder to drain your urine.

What happens after surgery for BPH? — After your procedure, you might be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Some people are able to go home the same day. Others need to spend the night in the hospital after surgery.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●You will most likely have a catheter in your bladder to drain urine. It is common for your urine to have a small amount of blood or blood clots in it. The doctor will remove the catheter in 1 to 7 days.

•Sometimes, after surgery, the doctor connects the catheter to fluids. This helps flush out your bladder.

•You might feel the need to urinate while the catheter is in place.

●You might have some pain or burning when you urinate after the catheter is removed.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of surgery for BPH? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Infection – Urinary tract infection is the most common.

●Problems with ejaculation – When this happens, semen goes into the bladder instead of out through the urethra.

●Loss of fertility – "Fertility" means being able to get a partner pregnant. If you want to have children, talk to your doctor before your procedure.

●Problem with urine control – This is rarely long-lasting.

●Injury to the urethra, which can cause growth of scar tissue

●Needing to have another procedure – This could happen if symptoms do not get better or return as the prostate continues to get bigger.

●Problems getting an erection

●Bleeding or small blood clots in urine

●A hole in the bladder

What else should I know? — Before you go home after surgery, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor or nurse's instructions. Ask questions about anything you do not understand.

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