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Decision Point

Enlarged prostate: Should I have surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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Enlarged prostate: Should I have surgery?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your
Summary

Get the facts

Your options

Have surgery for your enlarged prostate.
Don't have surgery.

Surgery can help some men whose symptoms bother them a lot. But other treatments usually are tried first. If you are trying to decide whether to treat your symptoms at all, see:

Enlarged prostate: Should I take medicine?

Key points to remember

Surgery can help if your enlarged prostate is causing serious problems—such as kidney problems or repeated urinary tract infections —or if medicines have not helped.
The most important factor in deciding whether to have surgery is how much the symptoms bother you.
Surgery works well for most men. But it can cause side effects, including ejaculation problems and erection problems.

FAQs

What are the treatments for an enlarged prostate?

Home treatment

Home treatment won't stop your prostate from getting larger. But it can help your symptoms. Try these home treatment tips:

Practice "double voiding." Urinate as much as you can. Then relax for a few moments and try to go again.
Avoid caffeine and alcohol.They make your body try to get rid of water and can make you urinate more often.
Try to avoid medicines that can make it hard to urinate.These include over-the-counter antihistamines, decongestants (including nasal sprays), and allergy pills. Check with your doctor or pharmacist about your medicines.

Medicine

If home treatment doesn't help, you can take medicine for an enlarged prostate. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.

Surgery

If your symptoms are very bad, your doctor may suggest surgery to remove part of your prostate. Few men have symptoms or other problems that are this bad.

What kinds of surgery are done for enlarged prostates?

The most common surgeries are:

TURP(transurethral resection of the prostate). A thin tool is inserted up the urethra to remove the section of prostate tissue that is blocking urine flow.
TUIP(transurethral incision of the prostate). A thin tool is inserted up the urethra. Then an electric current or a laser beam is used to make incisions in the prostate where it meets the bladder. This relaxes the opening to the bladder so that urine can flow out better. No tissue is removed.

Other types of surgery include:

There are some other surgeries that are used in rare cases. Talk to your doctor about these options.

How well does surgery work?

The American Urological Association (AUA) symptom index helps you describe how bad your symptoms are. This index can also be used to measure how well various treatments might work for your symptoms. But the most important thing is how much the symptoms bother you.

Symptoms get better for 70 to 100 out of every 100 men who have this surgery.¹

On average, men see an 85% improvement in their AUA symptom index scores.¹ For example, if you had a score of 25 (meaning severe symptoms), it might be reduced to about 4 (meaning mild symptoms).

Men who are very bothered by their symptoms are most likely to notice great improvement. Men who are not very bothered by their symptoms are less likely to notice a big change.

Symptoms get better for about 80 out of 100 men who have this surgery.¹

Men notice about a 73% improvement in their AUA symptom index scores.¹ For example, if you have a score of 25 (meaning severe symptoms), it could be reduced to about 6 (meaning mild symptoms).

Short-term improvement is about the same for TUIP as for TURP. Studies comparing the two types of surgery suggest that one works as well as the other.

What are the risks and side effects of surgery?

Both TURP and TUIP have possible side effects, such as:

Retrograde ejaculation. This means that semen flows backward into the bladder instead of out through the penis. It happens more often with TURP than with TUIP. It is not harmful, but it can affect your ability to father children.
Erection problems .
- Out of 100 men who have TURP, 3 to 35 report having erection problems. That means 65 to 97 out of 100 do not.¹
- Out of 100 men who have TUIP, 4 to 25 report having erection problems. That means 75 to 96 out of 100 do not.¹
Incontinence . A small number of men say they are unable to hold back their urine after surgery.

A few men will need a second operation several years later because their symptoms return. This can happen for a variety of reasons, such as if:

The surgery does not remove enough of the prostate.
The prostate continues to enlarge after surgery.
Scar tissue from the surgery blocks the urethra.

Why might your doctor recommend surgery for an enlarged prostate?

Your doctor may recommend surgery if:

You cannot urinate.
You have a partial blockage in your urethra that is causing repeated urinary tract infections, bladder stones, or bladder damage.
You have kidney damage.
Medicines have not helped.
You have too many side effects from the medicines.

Compare your options

Compare


What is usually involved?
What are the benefits?
What are the risks and side effects?

Have surgery for an enlarged prostate Have surgery for an enlarged prostate

You stay in the hospital for 1 or 2 days.
You are asleep or numb during the surgery.
You avoid strenuous activity and sex for about 6 weeks.

Surgery usually helps symptoms. The worse your symptoms are, the more improvement you're likely to see.

Side effects of surgery can include:
- Retrograde ejaculation.
- Erection problems.
- Incontinence.

Keep using medicines to treat your symptoms Keep using medicines to treat your symptoms

You take medicine every day.

Medicine helps symptoms for most men.

You have to take medicine for life, because symptoms will come back if you stop.
Side effects of medicines may include decreased sex drive, trouble getting an erection, tiredness, dizziness, headaches, and a stuffy nose.
Some medicines are available in generic forms that may cost less, but medicines can be very expensive.

Personal Stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about using surgery for benign prostatic hyperplasia

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

Over the past year, I've started to feel like my life revolves around the bathroom. I have to go every 2 or 3 hours, and in my line of work, that's a real inconvenience. And then sometimes it takes me 5 or 10 minutes to finish. It's become a real annoyance to me. I tried medicines to relax and shrink my prostate. But I didn't like the side effects, and I don't want to be on medication for the rest of my life. This surgery sounds like a good option for me. I think I can manage the possible side effects of the surgery a lot better than the symptoms I have now. It makes sense to me to take care of the problem and not just treat the symptoms.

John, age 56

I've adapted pretty well to the changes in my urination. Instead of standing there waiting for something to happen, I just have a seat, pick up a magazine, and let nature take its course. Some men might have a problem with that, but I'm retired and I don't find it a bother at all. I don't feel any need to have surgery, because I think I'm managing just fine. Who knows whether the risks of surgery might not be worse than what I'm dealing with now?

Geraldo, age 67

I haven't had a good night's sleep since this whole prostate thing started. I'm up every few hours almost every night. I find that I'm tired a lot during the day because I'm really not sleeping very well. I tried medicines, but they didn't seem to help me. I always had to have an aisle seat on airplanes because I was urinating so often. Every surgery I've ever had before has turned out well, so I'm not especially concerned about this one. In fact, I'm looking forward to finally getting to sleep through the night.

Tom, age 70

I just remarried after being single for about 15 years, and my new wife and I have a wonderful sex life. No way would I have surgery, no matter how many times I have to get up each night to use the bathroom! I know the risk of erection problems is very small, but it's not a risk I want to take right now.

Dave, age 65

If you need more information, see the topic Benign Prostatic Hyperplasia (BPH).

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for an enlarged prostate

Reasons not to have surgery

I don't want to keep taking medicine every day for my symptoms.

I don't mind taking daily medicine.

More important

Equally important

More important

I'm willing to try surgery because my symptoms bother me so much.

I don't like the idea of having surgery.

More important

Equally important

More important

I don't think medicines are helping my symptoms.

Medicines are helping my symptoms.

More important

Equally important

More important

I don't think the side effects of surgery will be as bad as my symptoms.

I think the side effects of surgery would bother me more than my symptoms do.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is surgery the best treatment for all types of enlarged prostates?

Yes Sorry, that's wrong. Most men can treat their symptoms at home or take medicines for their symptoms. Surgery can be helpful if an enlarged prostate is causing serious problems or if medicines aren't working.
No That's correct. Most men can treat their symptoms at home or take medicines for their symptoms. Surgery can be helpful if an enlarged prostate is causing serious problems or if medicines aren't working.
I'm not sure It may help to go back and read "What are the treatments for an enlarged prostate?" Most men can treat their symptoms at home or take medicines for their symptoms.

2.

Can surgery affect your ability to have children?

Yes That's right. Retrograde ejaculation, which means semen is ejaculated into the bladder instead of out through the penis, is a common side effect of surgery. That can make it difficult to father children.
No Sorry, you're wrong. Retrograde ejaculation, which means semen is ejaculated into the bladder instead of out through the penis, is a common side effect of surgery. That can make it difficult to father children.
I'm not sure It may help to go back and read "What are the risks and side effects of surgery?" Retrograde ejaculation is a common side effect that can make it difficult to father children.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all

Somewhat sure

Very sure

2.

Check what you need to do before you make this decision.

3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision

Next Steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts

Key concepts that you understood

Key concepts that may need review

Getting ready to act

Patient Choices

What matters to you

Credits and references

Credits

Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Christopher G. Wood, MD, FACS - Urology/Oncology

References

Citations

Fitzpatrick JM (2007). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3. pp. 2803–2844. Philadelphia: Saunders Elsevier.

Enlarged prostate: Should I have surgery?

You can use this information to talk with your doctor or loved ones about your decision.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery for your enlarged prostate.
Don't have surgery.

Surgery can help some men whose symptoms bother them a lot. But other treatments usually are tried first. If you are trying to decide whether to treat your symptoms at all, see:

Enlarged prostate: Should I take medicine?

Key points to remember

Surgery can help if your enlarged prostate is causing serious problems—such as kidney problems or repeated urinary tract infections —or if medicines have not helped.
The most important factor in deciding whether to have surgery is how much the symptoms bother you.
Surgery works well for most men. But it can cause side effects, including ejaculation problems and erection problems.

FAQs

What are the treatments for an enlarged prostate?

Home treatment

Home treatment won't stop your prostate from getting larger. But it can help your symptoms. Try these home treatment tips:

Practice "double voiding." Urinate as much as you can. Then relax for a few moments and try to go again.
Avoid caffeine and alcohol.They make your body try to get rid of water and can make you urinate more often.
Try to avoid medicines that can make it hard to urinate.These include over-the-counter antihistamines, decongestants (including nasal sprays), and allergy pills. Check with your doctor or pharmacist about your medicines.

Medicine

If home treatment doesn't help, you can take medicine for an enlarged prostate. Medicine can reduce the symptoms, but it rarely gets rid of them. If you stop taking medicine, symptoms return.

Surgery

If your symptoms are very bad, your doctor may suggest surgery to remove part of your prostate. Few men have symptoms or other problems that are this bad.

What kinds of surgery are done for enlarged prostates?

The most common surgeries are:

TURP(transurethral resection of the prostate). A thin tool is inserted up the urethra to remove the section of prostate tissue that is blocking urine flow.
TUIP(transurethral incision of the prostate). A thin tool is inserted up the urethra. Then an electric current or a laser beam is used to make incisions in the prostate where it meets the bladder. This relaxes the opening to the bladder so that urine can flow out better. No tissue is removed.

Other types of surgery include:

There are some other surgeries that are used in rare cases. Talk to your doctor about these options.

How well does surgery work?

The American Urological Association (AUA) symptom index helps you describe how bad your symptoms are. This index can also be used to measure how well various treatments might work for your symptoms. But the most important thing is how much the symptoms bother you.

Symptoms get better for 70 to 100 out of every 100 men who have this surgery.¹

On average, men see an 85% improvement in their AUA symptom index scores.¹ For example, if you had a score of 25 (meaning severe symptoms), it might be reduced to about 4 (meaning mild symptoms).

Men who are very bothered by their symptoms are most likely to notice great improvement. Men who are not very bothered by their symptoms are less likely to notice a big change.

Symptoms get better for about 80 out of 100 men who have this surgery.¹

Men notice about a 73% improvement in their AUA symptom index scores.¹ For example, if you have a score of 25 (meaning severe symptoms), it could be reduced to about 6 (meaning mild symptoms).

Short-term improvement is about the same for TUIP as for TURP. Studies comparing the two types of surgery suggest that one works as well as the other.

What are the risks and side effects of surgery?

Both TURP and TUIP have possible side effects, such as:

Retrograde ejaculation. This means that semen flows backward into the bladder instead of out through the penis. It happens more often with TURP than with TUIP. It is not harmful, but it can affect your ability to father children.
Erection problems .
- Out of 100 men who have TURP, 3 to 35 report having erection problems. That means 65 to 97 out of 100 do not.¹
- Out of 100 men who have TUIP, 4 to 25 report having erection problems. That means 75 to 96 out of 100 do not.¹
Incontinence . A small number of men say they are unable to hold back their urine after surgery.

A few men will need a second operation several years later because their symptoms return. This can happen for a variety of reasons, such as if:

The surgery does not remove enough of the prostate.
The prostate continues to enlarge after surgery.
Scar tissue from the surgery blocks the urethra.

Why might your doctor recommend surgery for an enlarged prostate?

Your doctor may recommend surgery if:

You cannot urinate.
You have a partial blockage in your urethra that is causing repeated urinary tract infections, bladder stones, or bladder damage.
You have kidney damage.
Medicines have not helped.
You have too many side effects from the medicines.

2. Compare Options

	Have surgery for an enlarged prostate	Keep using medicines to treat your symptoms
What is usually involved?	You stay in the hospital for 1 or 2 days. You are asleep or numb during the surgery. You avoid strenuous activity and sex for about 6 weeks.	You take medicine every day.
What are the benefits?	Surgery usually helps symptoms. The worse your symptoms are, the more improvement you're likely to see.	Medicine helps symptoms for most men.
What are the risks and side effects?	Side effects of surgery can include: Retrograde ejaculation. Erection problems. Incontinence.	You have to take medicine for life, because symptoms will come back if you stop. Side effects of medicines may include decreased sex drive, trouble getting an erection, tiredness, dizziness, headaches, and a stuffy nose. Some medicines are available in generic forms that may cost less, but medicines can be very expensive.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

If you need more information, see the topic Benign Prostatic Hyperplasia (BPH).

Personal stories about using surgery for benign prostatic hyperplasia

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

" Over the past year, I've started to feel like my life revolves around the bathroom. I have to go every 2 or 3 hours, and in my line of work, that's a real inconvenience. And then sometimes it takes me 5 or 10 minutes to finish. It's become a real annoyance to me. I tried medicines to relax and shrink my prostate. But I didn't like the side effects, and I don't want to be on medication for the rest of my life. This surgery sounds like a good option for me. I think I can manage the possible side effects of the surgery a lot better than the symptoms I have now. It makes sense to me to take care of the problem and not just treat the symptoms. "

— John, age 56

" I've adapted pretty well to the changes in my urination. Instead of standing there waiting for something to happen, I just have a seat, pick up a magazine, and let nature take its course. Some men might have a problem with that, but I'm retired and I don't find it a bother at all. I don't feel any need to have surgery, because I think I'm managing just fine. Who knows whether the risks of surgery might not be worse than what I'm dealing with now? "

— Geraldo, age 67

" I haven't had a good night's sleep since this whole prostate thing started. I'm up every few hours almost every night. I find that I'm tired a lot during the day because I'm really not sleeping very well. I tried medicines, but they didn't seem to help me. I always had to have an aisle seat on airplanes because I was urinating so often. Every surgery I've ever had before has turned out well, so I'm not especially concerned about this one. In fact, I'm looking forward to finally getting to sleep through the night. "

— Tom, age 70

" I just remarried after being single for about 15 years, and my new wife and I have a wonderful sex life. No way would I have surgery, no matter how many times I have to get up each night to use the bathroom! I know the risk of erection problems is very small, but it's not a risk I want to take right now. "

— Dave, age 65

3. Your Feelings

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for an enlarged prostate

Reasons not to have surgery

I don't want to keep taking medicine every day for my symptoms.

I don't mind taking daily medicine.

More important

Equally important

More important

I'm willing to try surgery because my symptoms bother me so much.

I don't like the idea of having surgery.

More important

Equally important

More important

I don't think medicines are helping my symptoms.

Medicines are helping my symptoms.

More important

Equally important

More important

I don't think the side effects of surgery will be as bad as my symptoms.

I think the side effects of surgery would bother me more than my symptoms do.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Your Decision

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having surgery

NOT having surgery

Leaning toward

Undecided

Leaning toward

Credits and references

Credits

Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer	Christopher G. Wood, MD, FACS - Urology/Oncology

References

Citations

Fitzpatrick JM (2007). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In AJ Wein, ed., Campbell-Walsh Urology, 9th ed., vol. 3. pp. 2803–2844. Philadelphia: Saunders Elsevier.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

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Last Updated:March 27, 2009

Author:Monica Rhodes

Medical Review: E. Gregory Thompson, MD - Internal Medicine & Christopher G. Wood, MD, FACS - Urology/Oncology

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