What procedures can cure Benign Prostatic Hyperplasia (BPH)?

Surgical Procedures That Can Cure Benign Prostatic Hyperplasia (BPH)

Surgery is the only definitive cure for BPH, with transurethral resection of the prostate (TURP) remaining the benchmark surgical procedure due to its established efficacy from randomized clinical trials with long-term follow-up. 1

Recommended Surgical Options for BPH Cure

• Transurethral Resection of the Prostate (TURP) - The gold standard surgical treatment that physically removes obstructing prostatic tissue 1
• Open Prostatectomy - 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 Incision of the Prostate (TUIP) - Effective for smaller prostates (less than 30g) 3
• 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 - Also known as visual laser ablation of the prostate 2

Indications for Surgical Intervention

Surgery is specifically recommended for patients with:

• Refractory urinary retention who have failed at least one attempt at catheter removal 2
• Renal insufficiency clearly due to BPH 2
• Recurrent urinary tract infections (UTIs) due to BPH 2
• Recurrent gross hematuria due to BPH 2
• Bladder stones clearly due to BPH and refractory to other therapies 2

Minimally Invasive Options

While these procedures may provide symptom relief, they are generally less effective than traditional surgical options for complete cure:

• Transurethral Microwave Thermotherapy (TUMT) - Uses microwave energy to heat and destroy excess prostate tissue 1
• Transurethral Needle Ablation (TUNA) - More effective than medical therapy but less effective than TURP 1

Procedures Not Recommended

• Balloon Dilation - Not recommended as a treatment option for BPH due to inadequate study results and significant failure rates over time 2
• High-Intensity Focused Ultrasound and Absolute Ethanol Injection - Considered investigational and should not be offered outside clinical trials 2
• Prostatic Artery Embolization (PAE) - Not recommended outside clinical trials according to the American Urological Association 4

Surgical Outcomes and Considerations

• TURP results in significant improvement in urinary symptoms with a 51% reduction in risk of acute urinary retention and a 55% reduction in risk for further BPH-related surgery compared to medical management 5
• Surgical complications may include sexual dysfunction, bladder neck contracture, need for blood transfusion, UTI, and hematuria 1
• Newer laser techniques may be preferred in patients on anticoagulation therapy 6
• High-volume surgeons are more likely to perform advanced techniques like holmium laser enucleation of the prostate (HoLEP) 6

Medical Alternatives (Not Curative)

While not curative, medical therapies can manage symptoms and potentially delay the need for surgery:

• Alpha-blockers (tamsulosin, alfuzosin, doxazosin, terazosin) provide symptomatic relief by relaxing prostatic smooth muscle 7
• 5-alpha-reductase inhibitors (finasteride, dutasteride) can reduce prostate size by approximately 18% over 4 years 5
• Combination therapy with both medication classes may be more effective than either alone 5

Remember that while medical therapies can effectively manage symptoms, only surgical intervention offers the potential for definitive cure of BPH by physically removing or destroying the obstructing prostatic tissue.