Surgery options for enlarged prostate

Surgery, sometimes, is needed to treat an enlarged prostate. That technology, too, is changing.

Transurethral resection of the prostate has been the standby surgery; it takes 60 to 90 minutes and can be done on an outpatient basis. New minimally invasive procedures that use microwaves (transurethral microwave thermotherapy) or radio frequency energy (transurethral needle ablation) to destroy excess tissue are now on the rise. They are done in half the time and don’t require anesthesia, says Dr. Steven Kaplan, a urologist at Weill Cornell Medical College in New York. “It’s just another option,” he says.

The minimally invasive treatments may be more effective than drugs in relieving the urinary problems that result from an enlarged prostate, but the jury is still out on whether they work as well as the standard surgical procedure.

A 2004 U.S. study reported in the Journal of Urology compared transurethral resection surgery with transurethral needle ablation in 121 men. It found similar improvement of urinary symptoms and flow rate, outcomes that remained stable for five years.

A 2007 study in Sweden and the U.S. published in the journal showed comparable positive outcomes in 154 men treated either with transurethral microwave thermotherapy or standard surgery.

Fewer side effects (such as retrograde ejaculation, in which semen flows into the bladder) were reported in men receiving the minimally invasive treatment in both studies. However, the reduction of prostate size is greater with surgery.

– Jill U. Adams