Prostate Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Prostate surgery covers minimally invasive and open procedures to treat benign prostatic hyperplasia (BPH) causing lower urinary tract symptoms, and radical procedures for prostate cancer. The most common BPH surgery is TURP (transurethral resection of the prostate); alternatives include laser enucleation (HoLEP) and vapourisation (GreenLight).

BPH surgery is indicated when medical therapy (alpha-blockers, 5-alpha reductase inhibitors) fails to control moderate-to-severe urinary symptoms, urinary retention occurs, or complications arise (bladder stones, recurrent UTI, renal impairment). Prostate cancer surgery (radical prostatectomy) is a separate procedure for localised malignancy.

TURP uses a resectoscope inserted through the urethra under spinal or general anaesthesia to remove obstructing prostatic tissue using electrocautery loops. HoLEP uses a holmium laser to enucleate the entire adenoma. Both remove tissue in chips (TURP) or large lobes (HoLEP) that are evacuated using a morcellator.

A urinary catheter remains in place for 24–48 hours after TURP. Haematuria resolves within 2–4 weeks. Strenuous activity is avoided for 2–4 weeks. Patients may experience temporary urinary urgency and dysuria. Ejaculation changes (retrograde ejaculation) affect 65–90% of TURP patients.

Risks include retrograde ejaculation (65–90%), urinary incontinence (1–2%), urethral stricture (3–5%), bleeding requiring transfusion (under 1% with bipolar TURP), TUR syndrome (rare with bipolar systems), and urinary tract infection. Erectile dysfunction occurs in 5–10% of patients.

TURP improves IPSS symptom scores by 70–80% and urine flow rate by 100–150%. HoLEP has comparable symptom improvement with lower retreatment rates and is now the preferred technique for large glands (over 80g). Symptom relief is durable in over 80% at 10 years.