Can a Person Have Prostatectomy and Still Have BPH?
No, a person cannot have BPH after a complete prostatectomy because BPH is a histologic diagnosis referring to tissue proliferation in the prostatic transition zone—tissue that is removed during prostatectomy. However, patients can still experience lower urinary tract symptoms (LUTS) after prostate surgery for other reasons.
Understanding BPH and Prostatectomy
BPH is specifically defined as the proliferation of glandular epithelial tissue, smooth muscle, and connective tissue within the prostatic transition zone 1. When a prostatectomy is performed—whether for BPH treatment (simple prostatectomy) or cancer (radical prostatectomy)—this tissue is removed 2.
Key Distinction
- BPH as a disease: Cannot exist without prostatic tissue 1
- LUTS (symptoms): Can persist or develop from other causes even after prostate removal 1
Post-Prostatectomy Urinary Symptoms
After BPH Surgery (TURP, Simple Prostatectomy)
Patients who undergo surgical treatment for BPH can experience persistent urinary symptoms, but these are not due to BPH itself:
- Incontinence rates: 0-8.4% of patients develop persistent stress urinary incontinence after open, laparoscopic, or endoscopic BPH surgery 1
- Causes of post-surgical symptoms include:
After Radical Prostatectomy
The entire prostate gland is removed, making BPH anatomically impossible 1. However, incontinence after prostate treatment (IPT) is common:
- Incontinence rates: 14-25% of men report bothersome leakage at 10 years post-radical prostatectomy 1
- This is iatrogenic incontinence, not BPH 1
Management of Post-Prostatectomy Symptoms
Evaluation Approach
When symptoms persist after prostatectomy, clinicians should assess 1:
- Type of incontinence: Stress urinary incontinence vs. urgency incontinence vs. mixed
- Severity: Mild (1-2 pads/day), moderate (2-4 pads/day), severe (5+ pads/day) 1
- Anatomic complications: Bladder neck contracture, urethral stricture via cystoscopy 1
- Bladder function: Consider urodynamic testing if diagnosis unclear 1
Treatment Options
Conservative management (first-line) 1:
- Pelvic floor muscle exercises
- Behavioral modifications
- Absorbent products for social continence
Surgical management for persistent symptoms at 6-12 months 1:
- Artificial urinary sphincter (preferred for moderate-severe incontinence) 1
- Male slings (for mild-moderate incontinence without radiation history) 1
- Urethral bulking agents (low efficacy, rarely curative, but least invasive option) 1
Common Pitfall to Avoid
Do not attribute post-prostatectomy LUTS to "recurrent BPH"—this is anatomically impossible after complete tissue removal 1, 2. Instead, investigate alternative causes including bladder dysfunction, sphincter damage, anatomic strictures, or medication effects 1, 3.