Download Prostate gland enlargement 前列腺肿大 http://www.mayoclinic.com

Prostate gland enlargement 前列腺肿大
http://www.mayoclinic.com/health/prostate-gland-enlargement/DS00027 19Dec2012Wed
Definition
Prostate gland enlargement is a common condition as men get older. Also called benign prostatic hyperplasia (BPH)
and prostatic hypertrophy, prostate gland enlargement can cause bothersome urinary symptoms. Untreated prostate
gland enlargement can block the flow of urine out of the bladder and can cause bladder, urinary tract or kidney
problems.
There are several effective treatments for prostate gland enlargement. In deciding the best option for you, you and
your doctor will consider your particular symptoms, the size of your prostate, other health problems you may have and
your preferences. Your choices may also depend on what treatments are available in your area. Treatments for
prostate gland enlargement include medications, lifestyle changes and surgery.
Symptoms
Prostate gland enlargement varies in severity among men and tends to gradually worsen over time. Prostate gland
enlargement symptoms include:

Weak urine stream

Difficulty starting urination

Stopping and starting while urinating

Dribbling at the end of urination

Frequent or urgent need to urinate

Increased frequency of urination at night (nocturia)

Straining while urinating

Not being able to completely empty the bladder

Urinary tract infection

Formation of stones in the bladder

Reduced kidney function
The size of your prostate doesn't necessarily mean your symptoms will be worse. Some men with only slightly
enlarged prostates have significant symptoms. On the other hand, some men with very enlarged prostates have only
minor urinary symptoms.
Only about half the men with prostate gland enlargement have symptoms that become noticeable or bothersome
enough for them to seek medical treatment. In some men, symptoms eventually stabilize and may even improve over
time.
When to see a doctor
If you're having urinary problems, see your doctor to check whether your symptoms are caused by an enlarged
prostate and find out what tests or treatment you may need. If you're unable to pass urine at all, seek immediate
medical attention.
If you don't find urinary symptoms too bothersome and they don't pose a health threat, you may not need treatment.
But you should still have your symptoms checked out by a doctor to make sure they aren't caused by another problem
such as prostate cancer.
Comparing normal and enlarged prostate glands http://www.mayoclinic.com/health/medical/IM00954
At normal size, the prostate gland is about the size and shape of a walnut or golf ball. When enlarged, the prostate may obstruct urine flow from the bladder and out the
urethra.
Causes
The prostate gland is the male organ that produces most of the fluid in semen, the milky-colored fluid that nourishes
and transports sperm out of the penis during ejaculation (orgasm). It sits beneath your bladder. The tube that
transports urine from the bladder out of your penis (urethra) passes through the center of the prostate. So, when the
prostate enlarges, it begins to block (obstruct) urine flow.
Most men have continued prostate growth throughout life. In many men, this continued growth enlarges the prostate
enough to cause urinary symptoms or to significantly block urine flow. Doctors aren't sure exactly what causes the
prostate to enlarge. It may be due to changes in the balance of sex hormones as men grow older.
Risk factors
The main risk factors for prostate gland enlargement include:

Aging. Prostate gland enlargement rarely causes signs and symptoms in men younger than 40. By 55, about 1 in 4
men have some signs and symptoms. By 75, about half of men report some symptoms.

Family history. Having a blood relative such as a father or brother with prostate problems means you're more likely to
have problems as well.

Where you're from. Prostate enlargement is more common in American and Australian men. It's less common in
Chinese, Indian and Japanese men.
Complications
Prostate gland enlargement becomes a serious problem when it severely interferes with your ability to empty your
bladder. If this is the case, you'll probably need surgery. Complications of enlarged prostate include:

Acute urinary retention. Acute urinary retention is a sudden, painful inability to urinate. This may occur after you've
taken an over-the-counter decongestant medication for allergies or a cold. When you are unable to urinate at all, your
doctor may thread a tube (catheter) through your urethra into your bladder. Or, your doctor may put in a suprapubic
tube — a catheter that drains your bladder through the lower abdomen. The type of catheter you need will depend on
your particular circumstances. Some men with an enlarged prostate require surgery or other procedures to relieve
urinary retention.

Urinary tract infections (UTIs). Some men with an enlarged prostate end up having surgery to remove part of the
prostate to prevent frequent urinary tract infections.

Bladder stones. These are mineral deposits that can cause infection, bladder irritation, blood in the urine and
obstruction of urine flow and are generally caused by the inability to completely empty the bladder.

Bladder damage. This occurs when the bladder hasn't emptied completely over a long period of time. The muscular
wall of the bladder stretches and weakens and no longer contracts properly. Often, symptoms of bladder damage
improve after prostate surgery or other treatment, but not always.

Kidney damage. This is caused by high pressure in the bladder due to urinary retention. This high pressure can
directly damage the kidneys or allow bladder infections to reach the kidneys. When an enlarged prostate causes
obstruction of the kidneys, a condition called hydronephrosis — a swelling of the urine-collecting structures in one or
both kidneys — may result.
Most men with an enlarged prostate don't develop these complications. However, acute urinary retention and kidney
damage in particular can be serious health threats when they do occur.
Preparing for your appointment
You're likely to start by seeing your primary care doctor for urinary symptoms caused by an enlarged prostate.
However, in some cases when you call to set up an appointment, you may be referred directly to a doctor who
specializes in urinary issues (urologist).
Because appointments can be brief, it's a good idea to be well prepared for your appointment. Here's some
information to help you get ready for your appointment, and know what to expect from your doctor.
What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you
scheduled the appointment.

Keep track of how often and when you urinate, how much liquid you drink, and if you feel you're completely emptying
the bladder when you urinate.

Bring a list of all medications, vitamins or supplements that you're taking.

Bring a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information
provided to you during an appointment. Someone who accompanies you may remember something that you missed
or forgot.

Know what tests and treatments you've had for enlarged prostate or urinary problems. For example, if you've
had infections, how often have you had them and what medications worked in the past?

Bring your prostate-specific antigen (PSA) test results if you've ever had your PSA checked.

Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together.
For an enlarged prostate evaluation, some basic questions to ask your doctor include:

Is an enlarged prostate or something else likely causing my symptoms?

Other than the most likely cause, what are other possible causes for my symptoms?

What tests do I need? Are there risks to any of these tests?

What are my treatment options?

What are the risks with each type of treatment?

What are the alternatives to the primary approach that you're suggesting?

I have these other health conditions. How can I best manage these conditions together?

Are there any restrictions on sexual activity that I need to follow?

Do I need to see a urologist?

Is there a generic alternative to the medicine you're prescribing me?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend
visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any additional questions that
come up during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any
points you want to spend more time on. Your doctor may ask:

When did you first begin noticing urinary symptoms?

Have your urinary symptoms been continuous, or occasional?

Have your symptoms gradually worsened over time, or did they come on suddenly?

How bothersome are your symptoms?

How often do you urinate during the day?

How often do you need to get up at night to urinate?

Do you start and stop when urinating, or feel like you have to strain to urinate?

Is it difficult for you to begin urinating?

Have you ever leaked urine? If so, when?

Do you have a frequent or urgent need to urinate?

Does it ever feel like you haven't completely emptied your bladder?

Do you ever have blood in your urine?

Have you had urinary tract infections?

Is there any burning when you urinate?

How do you know when you have a urinary tract infection?

Do you have type 2 diabetes?

Have you ever had any trouble getting and maintaining an erection (erectile dysfunction), or other sexual problems?

Do you feel pain in your bladder area?

Have you ever had surgery or another procedure that involved insertion of an instrument through the tip of your penis
into your urethra?

Do any of your blood relatives (such as your father or brother) have a history of enlarged prostate, or prostate cancer,
or kidney stones?

What medications do you take, including any over-the-counter medications or herbal remedies?

Are you on any blood thinners such as aspirin, warfarin (Coumadin) or clopidogrel (Plavix)?
Tests and diagnosis
An initial evaluation for enlarged prostate will likely include:

Detailed questions about your symptoms. Your doctor will want to know about other health problems you may
have, what medications you're taking and whether there's a history of prostate problems in your family. Your doctor
may have you complete a questionnaire such as the American Urological Association (AUA) Symptom Index for BPH.

Digital rectal exam. This exam can allow your doctor to check your prostate by inserting a finger into your rectum.
With this simple test, your doctor can determine whether your prostate is enlarged and check for signs of prostate
cancer.

Neurological exam. This is a brief evaluation of your mental functioning and nervous system. It can help identify
causes of urinary problems other than enlarged prostate. What this exam involves will depend on your specific
condition.

Urine test (urinalysis). Analyzing a sample of your urine in the laboratory can help rule out an infection or other
conditions that can cause similar symptoms.
Your doctor may use additional tests to rule out other problems and help confirm enlarged prostate is causing your
urinary symptoms. These can include:

Prostate-specific antigen (PSA) blood test. It's normal for your prostate gland to produce PSA, which helps liquefy
semen. When you have an enlarged prostate, PSA levels increase. However, PSA levels can also be elevated due to
prostate cancer, recent tests, surgery or infection (prostatitis).

Urinary flow test. This test measures the strength and amount of your urine flow. You urinate into a receptacle
attached to a special machine. The results of this test over time help determine if your condition is getting better or
worse.

Postvoid residual volume test. This test measures whether you can empty your bladder completely. This is often
done by using an ultrasound test to measure urine left in your bladder. Or, it may be done by inserting a tube (catheter)
into your bladder after you urinate.

Transrectal ultrasound. An ultrasound test provides measurements of your prostate and also reveals the particular
anatomy of your prostate. With this procedure, an ultrasound probe about the size and shape of a large cigar is
inserted into your rectum. Ultrasound waves bouncing off your prostate create an image of your prostate gland.

Prostate biopsy. With this procedure, a transrectal ultrasound guides needles used to take tissue samples of the
prostate. Examining tissues from a biopsy under a microscope can be help diagnose or rule out prostate cancer.

Urodynamic studies and pressure flow studies. With these procedures, a catheter is threaded through your urethra
into your bladder. Water (or less commonly air) is slowly injected into your bladder. This allows your doctor to measure
bladder pressures and to determine how well your bladder muscles are working.

Cystoscopy. Also called urethrocystoscopy, this procedure allows your doctor to see inside your urethra and bladder.
After you receive a local anesthetic, a lighted flexible telescope (cystoscope) is inserted into your urethra to look for
signs of problems.

Intravenous pyelogram or CT urogram. These tests can help detect urinary tract stones, tumors or blockages
above the bladder. First, dye is injected into a vein, and X-rays or CT scans are taken of your kidneys, bladder and the
tubes that connect your kidneys to your bladder (ureters). The dye helps outline the drainage systems of the kidneys.
Other possible causes of urinary symptoms
Your doctor will use these tests to make sure there isn't something else causing your problem, or if an enlarged
prostate has caused or worsened another problem. Problems that can cause urinary symptoms similar to those
caused by enlarged prostate include:

Bladder stones

Bladder and urinary tract infections

Diabetes

Neurological problems

Inflammation of the prostate (prostatitis)

Prostate cancer

Stroke

Muscle and nerve (neuromuscular) disorders

Scarring or narrowing of the urethra
Prostate cancer is entirely different than prostate gland enlargement, even though they can cause some similar
symptoms and may be detected by some of the same tests. Having an enlarged prostate doesn't reduce or increase
the risk of prostate cancer. Even if you're being treated for an enlarged prostate gland, you still need to continue
regular prostate exams to screen for cancer. Surgery for prostate gland enlargement may identify cancer in its early
stages.
Treatments and drugs
A wide variety of treatments are available for enlarged prostate. They include medications, surgery and minimally
invasive surgery. The best treatment choice for you depends on several factors, including how much your symptoms
bother you, the size of your prostate, other health conditions you may have, your age and your preference. If your
symptoms aren't too bad, you may decide not to have treatment and wait to see whether your symptoms become
more bothersome over time.
Medications
Medications are the most common treatment for moderate symptoms of prostate enlargement. Medications used to
relieve symptoms of enlarged prostate include:

Alpha blockers. These medications relax bladder neck muscles and muscle fibers in the prostate itself and make it
easier to urinate. These medications include terazosin, doxazosin (Cardura), tamsulosin (Flomax), alfuzosin (Uroxatral)
and silodosin (Rapaflo). Alpha blockers work quickly. Within a day or two, you'll probably have increased urinary flow
and need to urinate less often. These may cause a harmless condition called retrograde ejaculation — semen going
back into the bladder rather than out the tip of the penis.

5 alpha reductase inhibitors. These medications shrink your prostate by preventing hormonal changes that cause
prostate growth. They include finasteride (Proscar) and dutasteride (Avodart). They generally work best for very
enlarged prostates. It may be several weeks or even months before you notice improvement. While you're taking them,
these medications may cause sexual side effects including impotence (erectile dysfunction), decreased sexual desire
or retrograde ejaculation.

Combination drug therapy. Taking an alpha blocker and a 5 alpha reductase inhibitor at the same time is generally
more effective than taking just one or the other by itself.

Tadalafil (Cialis). This medication, from a class of drugs called phosphodiesterase inhibitors, is often used to treat
impotence (erectile dysfunction). It also can be used as a treatment for prostate enlargement. Tadalafil can't be used
in combination with alpha blockers. It also can't be taken with medications called nitrates, such as nitroglycerin.
Surgery
Your doctor may recommend surgery if medication isn't effective or if you have severe symptoms. There are several
types of surgery for an enlarged prostate. They all reduce the size of the prostate gland and open the urethra by
treating the enlarged prostate tissue that blocks the flow of urine. The decision about which type of surgery may be an
option is based on a number of factors, including the size of your prostate, the severity of your symptoms, and what
treatments are available in your area.
Any type of prostate surgery can cause side effects, such as semen flowing backward into the bladder instead of out
through the penis during ejaculation (retrograde ejaculation), loss of bladder control (incontinence) and impotence
(erectile dysfunction). Ask your doctor about the specific risks of each treatment you're considering.
Standard surgeries
Standard surgeries for an enlarged prostate include:
Transurethral resection of the prostate (TURP)
TURP has been a common procedure for enlarged prostate for many years, and it is the surgery with which other
treatments are compared. With TURP, a surgeon places a special lighted scope (resectoscope) into your urethra and
uses small cutting tools to remove all but the outer part of the prostate (prostate resection). TURP generally relieves
symptoms quickly, and most men have a stronger urine flow soon after the procedure. Following TURP, there is risk of
bleeding and infection, and you may temporarily require a catheter to drain your bladder after the procedure. You'll be
able to do only light activity until you're healed.
Transurethral incision of the prostate (TUIP or TIP)
This surgery is an option if you have a moderately enlarged or small prostate gland, especially if you have health
problems that make other surgeries too risky. Like TURP, TUIP involves special instruments that are inserted through
the urethra. But instead of removing prostate tissue, the surgeon makes one or two small cuts in the prostate gland to
open up a channel in the urethra — making it easier for urine to pass through.
Open prostatectomy
This type of surgery is generally done if you have a very large prostate, bladder damage or other complicating factors,
such as bladder stones. It's called open because the surgeon makes an incision in your lower abdomen to reach the
prostate. Open prostatectomy is the most effective treatment for men with severe prostate enlargement, but it has a
high risk of side effects and complications. It generally requires a short stay in the hospital and is associated with a
higher risk of needing a blood transfusion.
Minimally invasive surgery
Minimally invasive treatments are less likely to cause blood loss during surgery and require a shorter, if any, hospital
stay. These treatments also typically require less pain medication. Depending on the procedure — and how well it
works for you — you may need follow-up treatments.
Minimally invasive treatments include:
Laser surgery
Laser surgeries (also called laser therapies) use high-energy lasers to destroy or remove overgrown prostate tissue.
Laser surgeries generally relieve symptoms right away and have a lower risk of side effects than does TURP. Some
laser surgeries can be used in men who shouldn't have other prostate procedures because they take blood-thinning
medications.
Laser surgery can be done with different types of lasers and in different ways.

Ablative procedures (including vaporization) remove prostate tissue pressing on the urethra by burning it away,
easing urine flow. Ablative procedures may cause irritating urinary symptoms after surgery and may need to be
repeated at some point.

Enucleative procedures are similar to open prostatectomy, but with fewer risks. These procedures generally remove
all the prostate tissue blocking urine flow and prevent regrowth of tissue. One benefit of enucleative procedures over
ablative procedures is that removed prostate tissue can be examined for prostate cancer and other conditions.
Types of laser surgery include:

Holmium laser ablation of the prostate (HoLAP)

Visual laser ablation of the prostate (VLAP)

Holmium laser enucleation of the prostate (HoLEP)

Photoselective vaporization of the prostate (PVP)
Options for laser therapy depend on prostate size, the location of the overgrown areas, your doctor's recommendation
and your preferences. Choices available also depend on where you seek treatment. Not all facilities have lasers to
perform prostate surgery or doctors who have the specialized skills and training to do the procedures.
Transurethral microwave thermotherapy (TUMT)
With this procedure, your doctor inserts a special electrode through your urethra into your prostate area. Microwave
energy from the electrode generates heat and destroys the inner portion of the enlarged prostate gland causing it to
shrink and ease urine flow. This surgery has a lower risk of complications than does TURP, but is generally only used
on small prostates in special circumstances, because re-treatment may be necessary.
Transurethral needle ablation (TUNA)
With this outpatient procedure, a lighted scope (cystoscope) is passed into your urethra. Your doctor uses the scope
to place needles into your prostate gland. When the needles are in place, radio waves pass through them, heating and
destroying excess prostate tissue that's blocking urine flow. TUNA basically scars the prostate tissue, which causes it
to shrink and open up, easing urine flow. This type of surgery may be a good choice if you bleed easily or you have
certain other health problems. Like TUMT, TUNA may only partially relieve your symptoms and it may take some time
before you notice results. The risk of erectile dysfunction with the procedure is very low.
Prostatic stents
A prostatic stent is a tiny metal or plastic device that's inserted into your urethra to keep it open. Tissue grows over the
metallic stent to hold it in place. The plastic stent needs to be changed every four to six weeks but keeps you from
having to undergo any surgical procedure. In most cases, doctors don't consider stents a viable long-term treatment
because they can cause side effects including painful urination or frequent urinary tract infections. The metal stents
can be difficult to remove and are used only in special circumstances, such as for someone who can't have surgery.
Sometimes, plastic stents may be used temporarily before surgery to make sure you'll be able to urinate after your
surgery.
Lifestyle and home remedies
Making some lifestyle changes can often help control the symptoms of an enlarged prostate and prevent your
condition from worsening. Try these measures:

Limit beverages in the evening. Don't drink anything for an hour or two before bedtime to help you avoid wake-up
trips to the bathroom at night.

Don't drink too much caffeine or alcohol. These can increase urine production, irritate your bladder and worsen
your symptoms.

If you take water pills (diuretics), talk to your doctor. Maybe a lower dose, taking them only in the morning, or a
milder diuretic or change in the time you take your medication will help ease urinary symptoms. Don't stop taking
diuretics without first talking to your doctor.

Limit decongestants or antihistamines. These drugs tighten the band of muscles around your urethra that control
urine flow, which makes it harder to urinate.

Go when you feel the urge. Try to urinate when you first feel the urge. Waiting too long to urinate may overstretch
the bladder muscle and cause damage.

Schedule bathroom visits. Try to urinate at regular times to "retrain" the bladder. This can be done every four to six
hours during the day and can be especially useful if you have severe frequency and urgency.

Stay active. Inactivity causes you to retain urine. Even a small amount of exercise can help reduce urinary problems
caused by an enlarged prostate.

Urinate — and then urinate again a few moments later. This is known as double voiding.

Keep warm. Colder temperatures can cause urine retention and increase your urgency to urinate.
Alternative medicine
Studies on alternative therapy for an enlarged prostate have had mixed results. Sometimes these treatments appear
to help, while other times, they don't. Saw palmetto extract, which is made from the ripe berries of the saw palmetto
shrub, were believed to help reduce the symptoms of an enlarged prostate. But, research has found that the herbal
treatment is no more effective than a placebo.
Because there's no strong evidence that any herbal treatment can relieve urinary symptoms caused by an enlarged
prostate, the American Urological Association doesn't recommend any herbal treatments. In addition, certain herbal
products may increase your risk of bleeding or interfere with other medications you're taking.
Some of the herbal treatments that have been suggested as helpful for reducing enlarged prostate symptoms include:

Saw palmetto extract, made from the ripe berries of the saw palmetto shrub

Beta-sitosterol extracts, made from several plants, such as certain grasses and trees

Pygeum, an oil made from the bark of an African prune tree

Ryegrass extract, made from ryegrass pollen

Stinging nettle extract, made from the root of the stinging nettle plant
If you take any herbal remedies, be sure to tell your doctor. These may help treat some of your symptoms but are
generally less effective than are prescription medications.
Question http://www.mayoclinic.com/health/prostate-cancer/HO00032
PSA levels: Can they rise after prostate removal?
What causes PSA levels to increase after prostate removal due to benign prostatic hyperplasia (BPH)?
Answer from Erik P. Castle, M.D.
Increased levels of prostate-specific antigen (PSA) in your blood can be a sign of prostate cancer. However, cancer is
just one of several possible causes of increased PSA.
It's normal for prostate tissue to release small amounts of PSA into your bloodstream. When the prostate grows, PSA
levels increase. When the prostate is removed, PSA levels fall close to zero. Most procedures done for an enlarged
prostate remove only part of the prostate, which partially decreases PSA levels. A small amount of prostate tissue
may remain even after procedures that are considered a total removal of the gland. After any of these enlarged
prostate procedures, a number of things can cause PSA levels to go up again. They include:

Prostate cancer. Prostate cancer cells in remaining prostate tissue or in other parts of your body can release PSA.
Checking for signs of prostate cancer is the main reason men have PSA tests.

Recurrent benign prostate growth. Some prostate tissue remains even if your entire prostate is removed. This
tissue may continue to grow, leading to increased PSA levels.

Inflammation of prostate tissue (prostatitis). Infection or inflammation of the prostate gland or tissue remaining
after prostate surgery can cause your PSA levels to increase. Once prostatitis is treated with antibiotics, PSA levels
generally return to normal.

Recent ejaculation. Ejaculation (orgasm) can cause a temporary increase in PSA levels. To get the most accurate
reading, don't ejaculate for two days before you have a PSA test.
If you have elevated PSA levels after surgery for enlarged prostate, your doctor may recommend a wait-and-see
approach — advising you to retake the PSA test after two or three months. If your doctor suspects prostatitis, you may
be prescribed antibiotics to cure the infection. If a second test shows high PSA levels, your doctor may recommend
additional tests, such as other blood tests, urine tests or ultrasounds tests. If cancer is suspected, you may need a
biopsy to check remaining prostate tissue.
Question http://www.mayoclinic.com/health/bladder-outlet-obstruction/HO00023
Bladder outlet obstruction: Causes in men?
My doctor says I may have bladder outlet obstruction. What does that mean?
Answer
from Erik P. Castle, M.D.
Bladder outlet obstruction in men is a blockage that slows or stops urine flow out of the bladder.
Chronic bladder outlet obstruction causes urine to back up in your system, leading to difficulty urinating and other
bothersome urinary symptoms. If it isn't treated, bladder outlet obstruction can lead to bladder stones, infection and
damage to the bladder and kidneys.
There are a number of possible underlying causes of bladder outlet obstruction, including:

Enlarged prostate, also known as benign prostatic hyperplasia (BPH) — this is a common cause of bladder outlet
obstruction in men

Bladder stones

Certain medications, including antihistamines, decongestants or drugs to treat overactive bladder

Scarring of the urinary channel (urethra) or bladder neck, as a result of injury or surgery

Prostate cancer
Treatment options are based on the underlying cause of bladder outlet obstruction. If the cause is unclear, your doctor
will take some steps to help determine the origin of your symptoms. Your doctor or other medical professional may:

Perform a physical examination. This may include a digital rectal examination. During this test, your doctor will
insert a lubricated, gloved finger into your rectum. This allows your doctor feel the surface of your prostate gland to
look for signs of prostate enlargement or prostate cancer.

Conduct a bladder ultrasound. This can help determine how much urine remains in your bladder after you urinate.

Use a visual scope to look inside your urinary system (cystoscopy). This allows the doctor to examine your
prostate, urinary channel (urethra) and bladder for signs of problems.

Do other tests, such as blood tests or tests to measure urine flow.
Prompt diagnosis and treatment of bladder outlet obstruction is important to prevent serious problems caused by urine
backing up into your system.

Seek emergency treatment if you can't pass any urine and it feels like you have to. In the emergency room, a tube
(catheter) will be inserted through the tip of your penis and into your bladder to drain urine.

Go to the doctor if you can still urinate but have other signs or symptoms of bladder outlet obstruction — especially if
your symptoms are accompanied by fever and chills.
See Also

Prostate laser surgery

Open prostatectomy

Transurethral microwave therapy (TUMT)

Transurethral needle ablation (TUNA)

Transurethral incision of the prostate (TUIP)

General anesthesia
Prostate laser surgery
http://www.mayoclinic.com/health/prostate-laser-surgery/MY00611
Definition
Prostate laser surgery is a procedure to ease urinary symptoms caused by an enlarged prostate, a condition known as
benign prostatic hyperplasia (BPH). During prostate laser surgery, a combined visual scope and laser is inserted
through the tip of your penis into the tube that carries urine from your bladder (urethra). The urethra is surrounded by
the prostate. Using the laser, your doctor removes prostate tissue that's squeezing the urethra and blocking urine flow,
thus making a new larger tube for urine to pass through.
All lasers use concentrated light to generate precise and intense heat. There are two basic types of prostate laser
surgery:

Laser ablation melts away tissue to enlarge the urinary channel through your prostate. Photosensitive vaporization of
the prostate (PVP), sometimes called green light therapy, and HoLAP (holmium laser ablation of the prostate) are
examples of this type of procedure.

Laser enucleation uses a laser to cut away prostate tissue, as with traditional open prostate surgery. Holmium laser
enucleation of the prostate (HoLEP) is an example of this technique.
The type of prostate laser surgery your doctor will use depends on several factors, including the size of your prostate,
your health, the type of laser equipment available and your doctor's training.
Some types of laser surgery are also used to treat prostate cancer (which is unrelated to BPH).
Why it's done
Prostate laser surgery helps reduce urinary symptoms in most men with BPH. BPH symptoms can include:

A frequent, urgent need to urinate

Difficulty starting urination

Slow (prolonged) urination

Increased frequency of urination at night (nocturia)

Stopping and starting again while urinating

The feeling you can't completely empty your bladder

Urinary tract infections
Laser surgery may be done to treat or prevent complications due to blocked urine flow, such as:

Recurring urinary tract infections

Kidney malfunction or kidney damage

Bladder damage, which can result in an inability to control urination (incontinence) or an inability to urinate at all
(urinary retention)

Blood in your urine

Bladder stones
Nonlaser enlarged prostate treatments include transurethral needle ablation (TUNA), transurethral microwave therapy
(TUMT), transurethral incision of the prostate (TUIP), transurethral resection of the prostate (TURP) and open prostate
surgery (open prostatectomy).
Prostate laser surgery has several potential advantages over transurethral resection of the prostate (TURP) and open
prostatectomy, the enlarged prostate procedures to which others are generally compared. The advantages generally
include:

Lower risk of bleeding. Because there is a low risk of bleeding with laser surgery, it can be a good option for men
who take medication to thin their blood or who have a bleeding disorder that doesn't allow their blood to clot normally.

Shorter or no hospital stay. Laser surgery can generally be done without an overnight hospital stay (as an outpatient
procedure) or with only one night in the hospital. Other prostate treatments such as TURP or open prostatectomy may
require a longer hospital stay.

Quick recovery. Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.

Less need for a catheter. Enlarged prostate procedures generally require the use of a tube (catheter) to drain urine
from your bladder after surgery. With laser surgery, a catheter is generally needed for less than 24 hours.

More immediate results. Urinary results from laser surgery are noticeable right away, while it can take several weeks
to months to see noticeable improvement with other enlarged prostate procedures or with medications.
Transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT) and transurethral incision of the
prostate (TUIP) share some of the advantages of laser surgery. They're less involved (less invasive) than traditional
surgery, so healing is generally faster and there is typically less of a risk of complications. However they generally do
not work as well as tissue-removing options and often have to be repeated in three to five years. These procedures
are only done in men with certain types of prostates.
Risks
Serious long-term complications are less likely with prostate laser surgery than with traditional surgery. Risks of laser
surgery include:

Temporary difficulty urinating. You may have trouble urinating for a few days after the procedure. Until you can
urinate on your own, you will need to have a tube (catheter) inserted into your penis to carry urine out of your bladder.

Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An
infection is increasingly likely to occur the longer you have a catheter in place, and may require antibiotics or other
treatment.

Narrowing (stricture) of the urethra. Just as you can form scars on the outside of your body, you can form scars on
the inside after prostate surgery. These scars can block urine flow, requiring additional treatment.

Dry orgasm. Laser surgery can cause retrograde ejaculation, which means semen released during sexual climax
(ejaculation) enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful, and generally
doesn't affect sexual pleasure. But it can interfere with your ability to father a child. This is a common long-term side
effect of enlarged prostate procedures.

Need for re-treatment. Some men who have laser surgery later require more treatment. When laser surgery doesn't
provide symptom relief, or symptoms return over time, transurethral resection of the prostate (TURP), open
prostatectomy or HoLEP may be needed to reopen the urinary channel. The need for re-treatment is most common
with laser procedures that only remove part of the prostate (ablative procedures). Men who have HoLEP generally
don't require re-treatment, because the entire part of the prostate that can block urine flow is removed and can't grow
back.

Erection problems. There is a small risk that laser surgery could cause erectile dysfunction — the inability to
maintain an erection firm enough to have sex. This is generally less of a risk than it is with traditional surgery. It occurs
less often with HoLEP than with other laser procedures.
How you prepare
Follow your doctor's instructions on what to do before your treatment.

Ask about blood-thinning medications. Your doctor may ask you to stop taking medications that increase your risk
of bleeding several days prior to the procedure. These include warfarin (Coumadin), clopidogrel (Plavix) and
nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to
the doctor who prescribed you medication before you make any changes.

Don't eat before your procedure. Your doctor will likely tell you not to eat or drink anything after midnight. On the
morning of your procedure, take only the medications your doctor tells you to with a small sip of water.

Arrange a ride home ahead of time. You won't be able to drive yourself home after the procedure.

Arrange for time off work. You may not be able to work or do strenuous activity for about two weeks after surgery,
but depending on the type of laser procedure you have, you may need more or less recovery time. Ask your doctor
how much time you may need.
Your doctor may also give you other steps to follow.
What you can expect
Laser surgery techniques for enlarged prostate are all done by inserting viewing scopes and instruments through the
tip of the penis into the urethra. This makes surgery possible without making any cuts (incisions) on the outside of
your body. Exactly what you can expect during and after the procedure can vary somewhat depending on your
surgeon and the particular type of laser and technique used.
Holmium laser enucleation of the prostate (HoLEP)
During HoLEP, a laser is used to cut prostate tissue into small pieces. An instrument called a morcellator is used to
grind tissue into easily removable fragments. HoLEP cuts out the entire portion of the prostate gland that can block
urine flow. Because the entire prostate is removed, you won't need re-treatment, as you might with some other BPH
procedures.
HoLEP results are similar to those achieved with the most effective nonlaser prostate removal surgeries and open
prostatectomy. HoLEP generally has a lower risk of complications than open surgery or TURP.
One advantage of HoLEP over other laser treatments is that removed prostate tissue can be examined for signs of
prostate cancer.
The HoLEP technique is difficult for surgeons to learn and is only done at a few advanced medical centers.
Photosensitive vaporization of the prostate (PVP)
This type of surgery heats and melts away (vaporizes) enlarged prostate with extremely hot laser energy. It's done
with a potassium titanyl phosphate (KTP) laser or a lithium triborate (LBO) laser. The newer, higher powered LBO
system allows for a shorter operation time than older KTP lasers.
PVP is also called green light laser therapy, because the wavelength that the laser emits appears as green light.
More research is needed to better understand the safety and long-term results of PVP, particularly in men who need
to continue taking blood-thinning medications during the procedure and in men who have large prostates. The depth
of tissue penetration by the green light or KTP laser is much deeper than that with the holmium laser.
Holmium laser ablation of the prostate (HoLAP)
HoLAP is similar to PVP except that the laser energy source is different. The laser energy used is absorbed by water,
making it precise and keeping it from penetrating deep into tissues. The same type of laser is also used to treat
bladder or kidney tumors, open up scars that can block the urinary system, and break apart kidney or ureteral stones.
HoLAP and other laser ablation procedures are generally well suited for smaller prostates that still cause significant
urinary symptoms.
Prior to surgery
Before laser surgery, your doctor will give you one of two kinds of anesthesia:

General anesthesia, which means you'll be unconscious during the procedure.

Spinal anesthesia, which means you'll have an anesthetic injected into your spine to prevent pain. With spinal
anesthesia, you'll remain conscious during the procedure.
During the procedure
During laser surgery, a narrow fiber-optic scope is inserted through the tip of your penis into the urethra. The
instrument is used to focus a high-energy laser beam into prostate tissue blocking urine flow. Depending on the
procedure, the laser will come out of the fiber at an angle (side-firing laser fiber) for ablative procedures or the end
(end-firing laser fiber) for enucleative procedures. Depending on the procedure, your doctor will also use instruments
to remove pieces of prostate tissue from the prostate area and your bladder.
Laser procedures for enlarged prostate generally take from 30 minutes to an hour.
After the procedure
Ask your doctor about any specific restrictions or steps you need to take after the procedure.

Don't take blood-thinning medications until your doctor says it's OK.

Don't do any strenuous activity, such as heavy lifting, until your doctor says it's OK. This can be up to two weeks
after HoLEP, but as short as a few days with other procedures such as PVP.

Don't have sex until your doctor says it's OK. For most men, this is a week or two after the procedure. Having an
orgasm (ejaculating) too soon may cause pain and bleeding.

Pay attention to blood in your urine. Drink plenty of fluids and avoid strenuous activity unless your urine is clear
(and not pink), and the suggested time has passed.

Take antibiotics as prescribed. If your doctor prescribed antibiotics, make sure to take the full course of antibiotics
exactly as your doctor says.
You may need to have a urinary catheter in place after the procedure because urine flow is blocked by swelling. If
you're unable to urinate after the tube is removed, your doctor may give you catheters that you can insert on your own
a few times a day until swelling goes down and you can urinate again normally.
Results
It can take some time to recover fully from laser surgery. After the procedure, you may notice:

Blood in your urine (hematuria) for a few days to weeks after the procedure. See your doctor if the blood in your
urine is thick like ketchup, bleeding appears to be worsening or if blood clots block your urine flow.

Irritating urinary symptoms, such as painful urination, difficulty urinating, an urgent or frequent need to urinate, or
having to get up more often during the night to urinate. With some types of laser surgery, these symptoms can last up
to a few weeks after the procedure.

Difficulty holding urine. This can occur because your bladder is used to having to push urine through a urethra
narrowed by enlarged prostate tissue. For most men, this issue improves with time.
Prostate laser surgery improves urinary flow in most men. Often, results are quickly apparent. In some cases, laser
surgery doesn't completely remove all of the prostate tissue blocking urine flow, or tissue grows back, and further
treatment is needed.
Laser surgery techniques are still being developed, and more studies are needed to determine which ones work best
and their long-term effectiveness
Open prostatectomy
http://www.mayoclinic.com/health/open-prostatectomy/MY00610
Definition
Open prostatectomy is surgery to remove part of an enlarged prostate that's causing urinary symptoms.
Open prostatectomy is generally reserved for men who have a very large prostate, severe urinary symptoms or other
problems that need to be corrected during surgery. During open prostatectomy, the part of your prostate blocking
urine flow is removed through a cut (incision) below your navel. Or it may be done by making several smaller incisions
in the abdomen (laporascopically). Sometimes, robot assistance is used during prostatectomy.
Open prostatectomy is one of several options for treating an enlarged prostate, a condition also called benign prostatic
hyperplasia (BPH). To determine the best treatment choice for you, your doctor will consider the severity of your
symptoms, what other health problems you have, and the size and shape of your prostate. Open prostatectomy is
generally reserved for men who have relatively large prostates and for men for whom other surgical treatment options
are not available.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look
inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine
your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.
Why it's done
Open prostatectomy eases urinary symptoms and complications resulting from blocked urine flow. These can include:

A frequent, urgent need to urinate

Difficulty starting urination

Slow (prolonged) urination

Increased frequency of urination at night (nocturia)

Stopping and starting again while urinating

The feeling you can't completely empty your bladder

Urinary tract infections
Open prostatectomy may also be done to treat or prevent complications due to blocked urine flow, such as:

Recurring urinary tract infections

Kidney malfunction or kidney damage

Bladder damage, which can result in an inability to control urination (incontinence)

Blood in your urine

Bladder stones
Open prostatectomy works well at relieving urinary symptoms, but it's more involved and has a higher risk of
complications than other enlarged prostate procedures. It also requires a longer recovery time. For this reason, open
prostatectomy is done in only certain circumstances. It may be an option if you have:

A very large prostate

Bladder problems or other problems that can also be repaired during surgery

Bladder stones

Heavy prostate bleeding
New techniques and technology have made less invasive procedures an alternative to open prostatectomy for many
men. Other enlarged prostate procedures include transurethral needle ablation (TUNA), transurethral microwave
therapy (TUMT), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the
prostate (HoLEP) or laser photovaporization of the prostate (PVP), and transurethral resection of the prostate (TURP).
Risks
Open prostatectomy can cause temporary problems after surgery and can also cause long-term side effects or
complications. Risks of open prostatectomy include:

Incontinence. In some men, open prostatectomy causes loss of bladder control and an urgent need to urinate. In
most cases, this gets better after several weeks to several months.

Dry orgasm. Open prostatectomy causes retrograde ejaculation, which means the semen released during sexual
climax (ejaculation) enters your bladder rather than exiting the penis. It isn't harmful and generally doesn't affect
sexual pleasure, but it can interfere with your ability to father a child.

Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An
infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other
treatment.

Erectile dysfunction. In some cases, open prostatectomy causes erectile dysfunction — the inability to maintain an
erection firm enough to have sex. In some men erectile function can improve over time, but in many men it's
permanent.

Narrowing (stricture) of the urethra or bladder neck. Sometimes surgery narrows the tube that carries urine from
the bladder (urethra), or the area where the urethra attaches to the bladder (bladder neck). This can make urination
difficult and may require additional treatment to correct.

Heavy bleeding. Some men lose enough blood during open prostatectomy to require a blood transfusion. You may
store your own blood ahead of time in case this occurs, or you may be given donor blood if needed. In some cases,
bleeding occurs after surgery and requires further treatment.
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:

Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your
risk of bleeding several days prior to the procedure. These include warfarin (Coumadin), clopidogrel (Plavix) and
nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to
the doctor who prescribed you medication before you make any changes.

Don't eat before surgery. Your doctor will likely ask that you not eat or drink anything after midnight. On the morning
of your procedure, take only the medications your doctor tells you to with a small sip of water.

Arrange a ride home ahead of time. You won't be able to drive yourself home after the procedure.

Arrange for time off work. You may not be able to work or do strenuous activity for several weeks after surgery. Ask
your doctor how much recovery time you may need.

You surgeon may ask you to do an enema prior to surgery. You may be given a kit and instructions for giving
yourself an enema to clear your bowels the morning of surgery.
What you can expect
Open prostatectomy usually takes an hour and a half to three hours.
Before surgery, your doctor will give you a general anesthetic, which means you'll be unconscious during the
procedure. Or you may receive a spinal anesthetic, which means you'll be conscious during surgery but won't feel any
pain.
Your doctor will also give you an antibiotic right before surgery, to prevent infection.
During the procedure
Once the anesthetic is working, your doctor may perform a cystoscopy. A long, flexible viewing scope (cytoscope) is
inserted through the tip of your penis to see inside the urethra, bladder and prostate area.
Your doctor will then insert a tube (catheter) into the tip of your penis and extend it into your bladder. The tube drains
urine during the procedure. After your surgery area has been shaved and sterilized, your doctor will make a cut
(incision) below your navel. Depending on what technique your doctor uses, he or she may need to make an incision
through the bladder to reach the prostate. In some cases, the procedure is done with robot assistance or
laporascopically. Laparoscopic surgery requires a few smaller incisions rather than a single large incision.
If you also happen to have a hernia or bladder problem, your doctor may use the surgery as an opportunity to repair it.
Having mesh in place from a previous hernia repair may limit the ability to use robotic or laparoscopic techniques
during prostatectomy.
Once your doctor has removed the part of your prostate causing symptoms, you may have one to two temporary drain
tubes inserted through punctures in your skin near the surgery site. One tube goes directly into your bladder
(suprapubic tube), and the other tube goes into the area where the prostate was removed (pelvic drain).
After the surgery, your doctor will close the inside and outside of the surgery site with stitches or staples.
After the procedure
After surgery you will be watched carefully for any signs of trouble.

Your doctor may inflate a balloon inside the area where part of your prostate was removed. This puts pressure
on the surgery area to stop bleeding. To keep blood clots from forming, your will have saline solution flowing through
(irrigating) the bladder.

You'll be given intravenous (IV) pain medications. Your doctor may give you prescription pain pills to take after the
IV is removed.

You'll have stockings and compression devices on your legs. These help prevent blood clots.

Your doctor will have you walk the day of or the day after surgery. You'll also do exercises to move your feet
while you're in bed.

You'll likely go home a few days after surgery. When your doctor thinks it's safe for you to go home, the pelvic
drain is taken out. You may need to return to the doctor in one or two weeks to have staples taken out.

You'll likely return home with a catheter in place. Most men need a urinary catheter for seven to 10 days after
surgery.

The suprapubic tube is generally removed after a few days. It may be taken out before you go home from the
hospital. Or you may need to keep it in place and return to the hospital or doctor's office to have it removed.

Most men can resume sexual activity 6 to 8 weeks after surgery. After prostatectomy, you can still have an
orgasm during sex, but you'll ejaculate very little or no semen.
Make sure you understand the post-surgery steps you need to take, and any restrictions.

You'll need to resume your activity level gradually. You should be back to your normal routine in about four to six
weeks.

You won't be able to drive for at least a few days after going home. Don't drive until your catheter is removed, you
are no longer taking prescription pain medications and your doctor says it's OK.

You'll need to see your doctor a few times to make sure everything is OK. Most men see their doctors after about
six weeks and then again after a few months. If you have any problems, you may need to see your doctor sooner or
more often.
Results
Open prostatectomy provides long-term relief of urinary symptoms due to an enlarged prostate. Although it's the most
invasive procedure to treat an enlarged prostate, serious complications are rare. Most men who have the procedure
generally don't need any follow-up treatment.
Transurethral microwave therapy (TUMT)
http://www.mayoclinic.com/health/tumt/MY00607
Definition
Transurethral microwave therapy (TUMT) is an outpatient procedure to treat urinary symptoms caused by an enlarged
prostate, also known as benign prostatic hyperplasia (BPH). It's used less often now than it was in the past and has
generally been replaced by newer treatments.
During TUMT, a small microwave antenna is inserted through the tip of your penis into the tube that carries urine from
your bladder (urethra). The antenna is extended until it reaches the area of the urethra surrounded by the prostate.
Your doctor then uses the antenna to emit a dose of microwave energy that heats up and destroys excess prostate
tissue blocking urine flow.
TUMT is one of several options for treating an enlarged prostate. To determine the best treatment choice for you, your
doctor will consider how severe your symptoms are, what other health problems you have, and the size and shape of
your prostate.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look
inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine
your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.
Why it's done
TUMT is a treatment to ease urinary symptoms and complications resulting from blocked urine flow, such as:

A frequent, urgent need to urinate

Difficulty starting urination

Slow (prolonged) urination

Increased frequency of urination at night (nocturia)

Stopping and starting again while urinating

The feeling you can't completely empty your bladder

Urinary tract infections
TUMT is not done to treat prostate cancer.
Other enlarged prostate procedures include transurethral resection of the prostate (TURP), transurethral needle
ablation (TUNA), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the
prostate (HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.
TUMT improves urinary flow in some, but not all, men. This procedure is generally more effective than are
medications at improving urine flow, but less effective than is surgery (TURP or open prostatectomy). TUMT is less
involved than surgery is and has a lower risk of side effects than do the more-invasive surgeries.
Only men with prostates of a certain size and shape can benefit from TUMT. It works best for men who have a
moderately enlarged prostate. It may not be effective if your prostate has an enlarged middle lobe that grows upward
into your bladder. In such cases, the microwave antenna may not produce enough energy to reach the part of your
prostate blocking urine flow.
In the long term, surgery is more effective than is TUMT for relieving urinary symptoms. But TUMT has several
advantages over surgery:

It's done without an overnight hospital stay (on an outpatient basis).

It's less likely to cause erectile dysfunction or other sexual side effects.

It doesn't require general or spinal anesthesia.

It has a lower risk of causing heavy bleeding.

It may be a safer alternative if surgery isn't a good choice for you because of certain other health problems.
Risks
Risks of TUMT include:

Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An
infection is increasingly likely to occur the longer you have a tube to drain urine (urinary catheter) in place after the
procedure. It may require antibiotics or other treatment.

Narrowing (stricture) of the urethra or bladder neck. Sometimes TUMT narrows the tube that carries urine from
the bladder (urethra), or the area where the urethra attaches to the bladder (bladder neck). This can make urination
difficult and may require additional treatment to correct.

Dry orgasm. TUMT can cause retrograde ejaculation, which means semen released during sexual climax (ejaculation)
enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful and generally doesn't affect
sexual pleasure. But it can interfere with your ability to father a child.

Damage to the genitals. Unintentional overexposure to microwave radiation can cause serious damage to the penis,
urethra or other parts of the genital area. This is rare.

Need for retreatment. Some men who have TUMT later require follow-up treatment with TURP or another prostate
procedure. Treatment is needed either because symptoms return or because they never adequately improve.
Because of potential complications, TUMT may not be a treatment option if you have or have had:

A penile implant

Certain types of surgery in the pelvic area

Urethral stricture — narrowing of urethra

Radiation treatments in the pelvic area

A pacemaker or an implanted defibrillator — talk with your doctor to find out whether the device can be deactivated for
the procedure
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:

Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your
risk of bleeding several days prior to the procedure. These include warfarin (Coumadin), clopidogrel (Plavix), and
nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to
the doctor who prescribed your medication before you make any changes.

Don't eat before your procedure. Your doctor may ask you to not eat or drink anything after midnight. On the
morning of your procedure, take only the medications your doctor tells you to with a small sip of water.

Arrange a ride home. You won't be able to drive yourself home after the procedure.
Your doctor may also give you other steps to follow.
What you can expect
TUMT takes less than an hour. It's usually done as an outpatient procedure, which means you'll go home the day of
the procedure.
Transurethral microwave therapy (TUMT)
http://www.mayoclinic.com/health/medical/IM03965
Transurethral microwave therapy (TUMT) uses heat to destroy enlarged
You'll be given a local anesthetic to numb the prostate area. The anesthetic may be inserted through the tip of your
penis, or given in a shot via your rectum or in the space between your scrotum and anus (perineum).
You'll likely have intravenous (IV) sedation. With IV sedation, you'll be drowsy but remain conscious during the
procedure.
During the procedure
Once the anesthetic is working, your doctor will insert a catheter with a microwave antenna into your urethra. A
thermometer is inserted into your rectum to check temperature. Both will have balloons attached that hold them in
place. Your doctor may check the placement of the catheter and the rectal thermometer using an ultrasound machine.
Once the antenna is in exactly the right place, your doctor will start the procedure. The microwave antenna will cause
just enough heat to destroy the prostate tissue blocking your urine flow, but not enough to damage other tissue.
During microwave treatment, water circulates around the tip and sides of the antenna to protect the urethra from heat.
Your doctor will give you enough pain medication so that it won't hurt too much — but you'll still feel some heat and
discomfort in the prostate and bladder areas. Your doctor will tell you how much discomfort to expect during the
procedure and may show you how to use an emergency stop button if the pain gets too bad.
Feeling a little discomfort during the procedure is necessary. Your doctor will ask you about your pain level and adjust
your treatment to make sure you're getting enough heat to improve your symptoms — but not so much that it causes
unnecessary damage. You'll need to stay as still as possible during the actual microwave treatment. The length of
treatment time varies depending on your doctor's preference and the type of microwave therapy machine used.
During treatment, you may have a strong desire to urinate and may feel bladder spasms — sensations that usually go
away after the treatment is finished.
After the procedure
After TUMT, you may have a tube (catheter) inserted into the tip of your penis that extends into your bladder. This
allows you to pass urine until you can urinate on your own.
After the procedure, follow your doctor's instructions for recovery.

Don't take blood-thinning medications until your doctor says it's OK.

Don't do any strenuous activity, such as heavy lifting, for three to five days.

Don't drive for the rest of the day after your procedure.

Don't have sex until your doctor says it's OK. Most men can resume sexual activity about two weeks following the
procedure.
Short-term side effects of TUMT can include:

Blood in your urine (hematuria) for a few days after the procedure.

Irritating urinary symptoms such as painful urination, difficulty urinating, or an urgent or frequent need to urinate.
These symptoms usually improve within a few weeks.
Results

Several weeks to months may pass before you see a noticeable improvement in urinary symptoms. That's
because your body needs time to break down and absorb overgrown prostate tissue that's been destroyed by
microwave energy.

Some men need retreatment in time. More studies are needed to determine the overall, long-term
effectiveness of TUMT compared with other procedures.

After TUMT, it's important to have a digital rectal exam once a year to check your prostate and screen for
prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment
to see your doctor.
Transurethral needle ablation (TUNA)
http://www.mayoclinic.com/health/tuna/MY00608
Definition
Transurethral needle ablation (TUNA) is an outpatient procedure to treat urinary symptoms caused by an enlarged
prostate. This procedure is also called radiofrequency ablation or RF therapy for enlarged prostate.
During TUNA, a specially adapted visual instrument (cystoscope) is inserted through the tip of your penis into the tube
that carries urine from your bladder (urethra). Using the cystoscope, your doctor guides the placement of tiny needles
into your prostate. Then radio waves are passed through the needles to create scar tissue. This scarring shrinks
prostate tissue, opening up the urinary channel so urine can flow more easily.
TUNA is one of several options for treating an enlarged prostate, a condition also known as benign prostatic
hyperplasia (BPH). To determine the best treatment choice for you, your doctor will consider how severe your
symptoms are, what other health problems you have, and the size and shape of your prostate.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look
inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine
your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.
Why it's done
TUNA is used to ease urinary symptoms and complications resulting from blocked urine flow, such as:

A frequent, urgent need to urinate

Difficulty starting urination

Slow (prolonged) urination

Increased frequency of urination at night (nocturia)

Stopping and starting again while urinating

The feeling you can't completely empty your bladder

Urinary tract infections
Other enlarged prostate procedures include transurethral resection of the prostate (TURP), transurethral microwave
therapy (TUMT), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the
prostate (HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.
In the long term, TUNA is less effective than is TURP or open prostatectomy. But, TUNA has several advantages over
surgery:

For most men, it's done without an overnight hospital stay (on an outpatient basis).

It has lower risk factors for bleeding and other complications than does surgery.

It may be a safer alternative if surgery isn't a good choice for you because of certain other health problems.

It is less likely to cause difficulty holding urine (urinary incontinence) than is surgery.
Risks
Risks of TUNA include:

Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An
infection is increasingly likely to occur the longer you have a tube to drain urine (urinary catheter) in place after the
procedure. It may require antibiotics or other treatment.

Need for retreatment. Some men who have TUNA later require more treatment to ease urinary symptoms — usually
surgery. Some men need further treatment because they develop long-term prostate irritation that can cause swelling
and pain (chronic prostatitis).
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:

Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your
risk of bleeding several days prior to the procedure. These include warfarin (Coumadin), clopidogrel (Plavix), and
nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to
the doctor who prescribed your medication before you make any changes.

Don't eat before your procedure. Your doctor will likely ask you to not eat or drink anything after midnight. On the
morning of your procedure, take only the medications your doctor tells you to with a small sip of water.

Arrange a ride home. You won't be able to drive yourself home after the procedure. Ask your doctor ahead of time
how long you can expect to be at the surgery center or hospital.
Your doctor may also give you other steps to follow.
What you can expect
TUNA takes less than an hour. It's usually done as an outpatient procedure, which means you will go home the day of
the procedure.
You may be given an enema kit, which is used to clear your bowels and rectum at home, the morning of surgery.
Shortly before your treatment, you will be asked to urinate so that your bladder is empty.
You'll be given a local anesthetic to numb the prostate area. The anesthetic may be inserted through the tip of your
penis, or given in a shot via your rectum or in the area between your scrotum and anus (perineum).
You may also have intravenous (IV) sedation. With IV sedation, you'll be drowsy but remain conscious during the
procedure. In some cases, spinal anesthesia or general anesthesia is used. With spinal anesthesia, you're numb from
the waist down. With general anesthesia, you are unconscious during the procedure.
During the procedure
Once the anesthetic is working, a specially adapted visual instrument (cystoscope) is passed through the opening of
your penis into your urethra. Your doctor will insert the cystoscope until it reaches the prostate area.
When the cystoscope is in place, your doctor will insert small needles into your prostate through the end of the
cystoscope. Then, radio waves pass through them to heat and destroy prostate tissue blocking urine flow. You may
feel a little pain or discomfort. The procedure generally takes about 45 minutes.
After the procedure
After TUNA, you'll have a catheter that extends through the tip of penis into your bladder. This allows you to pass
urine until you can urinate on your own.
After the procedure, follow your doctor's instructions for recovery.

Don't take blood-thinning medications until your doctor says it's OK.

Don't do any strenuous activity, such as heavy lifting, for three to five days.

Don't drive for the rest of the day after your procedure.

Don't have sex until your doctor says it's OK. Most men can resume sexual activity after a few weeks.
Ask your doctor about any specific restrictions or other steps you need to take after the procedure. Your doctor may
prescribe antibiotics to prevent infection and medications to reduce pain.
Side effects of TUNA can include:

Blood in your urine (hematuria) for a few days after the procedure.

Irritating urinary symptoms such as painful urination, difficulty urinating, or an urgent or frequent need to urinate.
These symptoms usually improve within a week or so.

Temporary difficulty urinating. A number of men have trouble urinating (urinary retention) after the procedure. If this
happens, you may need to have a catheter in place for a few days. In some cases, a catheter is needed for a few
weeks or longer.

Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An
infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other
treatment. Some men have recurring urinary tract infections after TUNA.
Results

Several weeks may pass before you see a noticeable improvement in your urinary symptoms. It can take a
few months for some men to notice significant improvement. That's because your body needs time to break
down and absorb prostate tissue that has been destroyed.

Some men who have TUNA will eventually need additional procedures for enlarged prostate. More studies are
needed to determine the overall, long-term effectiveness of TUNA compared with other procedures.

After TUNA, it's important to have a digital rectal exam once a year to check your prostate and screen for
prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment
to see your doctor.
Transurethral resection of the prostate (TURP)
http://www.mayoclinic.com/health/turp/MY00633
Definition
Transurethral resection of the prostate (TURP) is a type of prostate surgery done to relieve moderate to severe urinary
symptoms caused by an enlarged prostate. During TURP, a combined visual and surgical instrument (resectoscope)
is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The urethra is
surrounded by the prostate. Using the resectoscope, your doctor trims away excess prostate tissue that's blocking
urine flow.
TURP is one of the most effective options for treating an enlarged prostate, a condition also known as benign prostatic
hyperplasia (BPH). To determine whether TURP or another treatment is the best choice for you, your doctor will
consider how severe your symptoms are, what other health problems you have, and the size and shape of your
prostate.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look
inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine
your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.
Why it's done
TURP helps reduce urinary symptoms in most men with BPH. It's best suited for men who have larger prostate glands
and moderate to severe urinary symptoms. It has better long-term results than do medications and many other
treatments for enlarged prostate.
Urinary symptoms caused by BPH can include:

A frequent, urgent need to urinate

Difficulty starting urination

Slow (prolonged) urination

Increased frequency of urination at night (nocturia)

Stopping and starting again while urinating

The feeling you can't completely empty your bladder

Urinary tract infections
TURP may also be done to treat or prevent complications due to blocked urine flow, such as:

Recurring urinary tract infections

Kidney malfunction or kidney damage

Bladder damage, which can result in an inability to control urination (incontinence)

Blood in your urine

Bladder stones
Men who have TURP are less likely to need retreatment later than are men who opt for other, less invasive prostate
procedures. But TURP is more likely to cause complications and generally requires a longer recovery period.
Other enlarged prostate procedures include transurethral needle ablation (TUNA), transurethral microwave therapy
(TUMT), transurethral incision of the prostate (TUIP), laser surgery such as holmium laser enucleation of the prostate
(HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.
Less invasive treatments generally don't provide the long-lasting results that TURP and open prostatectomy do. But a
number of other prostate procedures are becoming more effective with the development of improved techniques and
surgical tools. Some men opt for a less invasive procedure first, and then have TURP done later if symptoms don't
improve or they get worse over time. Even with TURP, some men need additional procedures, typically five to 10
years following TURP.
Risks
TURP is a safe procedure for most men. Risks can include:

Temporary difficulty urinating. You may have trouble urinating (urinary retention) for a few days after the procedure.
Until you can urinate on your own, you will need to have a tube inserted through your penis to carry urine out of your
bladder (urinary catheter).

Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An
infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other
treatment. In some cases, men who have TURP have recurring urinary tract infections.

Heavy bleeding. Some men lose enough blood during TURP to require a blood transfusion. This is rare. Men with
larger prostates appear to be at higher risk of significant blood loss.

Difficulty holding urine. Rarely, loss of bladder control (incontinence) is a long-term complication of TURP.

Dry orgasm. TURP can cause retrograde ejaculation, which means semen released during sexual climax (ejaculation)
enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful and generally doesn't affect
sexual pleasure. But it can interfere with your ability to father a child. This long-term side effect occurs in about 75
percent of men who have TURP.

Erectile dysfunction. The inability to keep or maintain an erection is a possible long-term side effect of TURP. While
this isn't common with TURP, it can occur.

Low sodium in the blood. This rare complication is called TURP syndrome or transurethral resection (TUR)
syndrome. It occurs when the body absorbs too much of the fluid used to wash (irrigate) the surgery area during the
procedure. TUR syndrome is rare, but can be life-threatening if it isn't treated. A technique called bipolar TURP allows
the use of a salt (saline) solution for irrigation, which lessens the risk of TURP syndrome.

Need for retreatment. Some men require follow-up treatment after TURP, either because symptoms return over time
or because they never adequately improve. This is less common with TURP than with less invasive office-based
prostate treatments. In some cases, further treatment is needed because TURP causes narrowing (stricture) of the
urethra or the bladder neck.
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:

Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your
risk of bleeding several days prior to the surgery. These include warfarin (Coumadin), clopidogrel (Plavix), and
nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to
the doctor who prescribed your medication before you make any changes.

Don't eat before your procedure. Your doctor will likely ask you to not eat or drink anything after midnight. On the
morning of your procedure, take only the medications your doctor tells you to with a small sip of water.

Arrange a ride home. You won't be able to drive yourself home after the procedure.

Plan for time off work. You may not be able to work or do strenuous activity for several weeks after surgery (typically
three to six weeks). Ask your doctor how much recovery time you may need.
Your doctor may also give you other steps to follow.
Transurethral resection of the prostate (TURP)
http://www.mayoclinic.com/health/medical/IM03970
In transurethral resection of the prostate (TURP), a combined visual and surgical instrument (resectoscope) is inserted through the urethra where it's surrounded by
prostate tissue. An electrical loop cuts away excess prostate tissue to improve urine flow.
What you can expect
TURP generally takes 60 to 90 minutes. You'll be given either a spinal anesthetic, which allows you to be awake
during the procedure but unable to feel pain in the surgical area, or a general anesthetic, which will put you to sleep.
The doctor may also give you a dose of antibiotics to prevent infection.
During the procedure
Once the anesthetic is working, a combined visual and surgical instrument (resectoscope) is inserted into the tip of
your penis and extended through your urethra and into the prostate area. By accessing the prostate through your
penis, your doctor won't need to make any cuts (incisions) on the outside of your body. The resectoscope is about 12
inches (30.5 centimeters) long and 1/2 inch (1 centimeter) in diameter. It has a light, valves for controlling irrigating
fluid, and an electrical loop to cut tissue and seal blood vessels.
The doctor will use the resectoscope to trim tissue from the inside of your prostate gland, one small piece at a time. As
small pieces of tissue are cut from inside your prostate, irrigating fluid carries them into your bladder. They're removed
at the end of the operation.
BPH usually isn't a symptom of prostate cancer, and it doesn't increase your risk of prostate cancer. But your doctor
may recommend the prostate tissue from your procedure be sent to a lab to check for hidden cancer cells.
After the procedure
After surgery, you'll need to stay in the hospital for one to two days. Talk to your doctor about what you can expect,
and any precautions you need to take after you go home.

You'll have a catheter in place that enters through the tip of your penis and goes into your bladder to drain your
urine into a collection bag. The catheter is generally left in place for four to seven days, until you're able to urinate on
your own. In some cases, a catheter is needed for a longer period of time — especially if you have a relatively large
prostate. You may urinate around the catheter, which is normal because your bladder may try and squeeze out more
urine than the catheter can accommodate.

Urination may be painful, or you may have a sense of urgency as urine passes over the surgical area. You may also
need to urinate frequently. Painful urination generally improves in one to four weeks.

Expect some blood in your urine right after surgery. If you have clots or so much blood in your urine that you can't
see through it, contact your doctor.
These steps can help you recover after your procedure.

Drink plenty of water to flush out the bladder.

Avoid constipation and straining during a bowel movement. Eat fiber-containing foods and avoid foods that can
cause constipation. Ask your doctor if you should take a laxative if you do become constipated.

Don't take blood-thinning medications until your doctor says it's OK.

Don't do any strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK.

Don't have sex. You'll likely be able to resume sexual activity in about four to six weeks.

Don't drive until your doctor says it's OK. Generally, you can drive once your catheter is removed and you're no
longer taking prescription pain medications.
Results
TURP typically relieves symptoms quickly. Most men experience a significantly stronger urine flow within a
few days. Follow-up treatment to ease symptoms is sometimes needed, particularly after several years
have passed.
After TURP, it's important to have a digital rectal exam once a year to check your prostate and screen for
prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an
appointment to see your doctor.
Transurethral incision of the prostate (TUIP)
http://www.mayoclinic.com/health/tuip/MY00599
Definition
Transurethral incision of the prostate (TUIP) is a type of prostate surgery done to relieve urinary symptoms caused by
prostate enlargement, also known as benign prostatic hyperplasia (BPH).
During TUIP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and
into the tube that carries urine from your bladder (urethra). The urethra is surrounded by prostate tissue. No prostate
tissue is removed during TUIP. Instead, the doctor cuts one or two small grooves in the area where the prostate and
the bladder are connected (bladder neck) in order to open up the urinary channel. This allows urine to pass through
more easily.
When deciding whether TUIP or another treatment is a good option for you, your doctor will consider how severe your
symptoms are, what other health problems you have, and the size and shape of your prostate.
Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look
inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine
your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow
Why it's done
TUIP is used to ease urinary symptoms caused by an enlarged prostate. Symptoms can include:

A frequent, urgent need to urinate

Difficulty starting urination

Slow (prolonged) urination

Increased frequency of urination at night (nocturia)

Stopping and starting again while urinating

The feeling you can't completely empty your bladder

Urinary tract infections
TUIP may also be done to treat or prevent complications due to blocked urine flow, such as:

Recurring urinary tract infections

Kidney malfunction or kidney damage

Bladder damage, which can result in an inability to control urination (incontinence)

Blood in your urine

Bladder stones
TUIP is an option only when the prostate gland is relatively small — less than about 1 ounce (30 milliliters) in size. If
you have a larger prostate or you have severe urinary symptoms, a different procedure may be a better option.
Other enlarged prostate procedures include transurethral resection of the prostate (TURP), transurethral needle
ablation (TUNA), transurethral microwave therapy (TUMT), laser surgery such as holmium laser enucleation of the
prostate (HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.
TUIP is less likely than TURP or open prostatectomy to cause serious bleeding and surgery-related complications.
Other enlarged prostate treatments, including holmium laser enuclation of the prostate (HoLEP), appear to be more
effective than is TUIP at easing urinary symptoms in the long run.
Risks
Risks of TUIP can include:

Temporary difficulty urinating. You may have trouble urinating (urinary retention) for a few days after the procedure.
Until you can urinate on your own, you will need to have a tube inserted through your penis to carry urine out of your
bladder (urinary catheter).

Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An
infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other
treatment.

Difficulty holding urine. You may have trouble controlling urination (urinary incontinence) right after surgery. Rarely,
this is a long-term consequence of TUIP.

Dry orgasm. TUIP can cause retrograde ejaculation, which means semen released during sexual climax (ejaculation)
enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful and generally doesn't affect
sexual pleasure. But it can interfere with your ability to father a child.

Erectile dysfunction. The inability to keep or maintain an erection is a possible long-term side effect, but is less
common with TUIP than with open prostatectomy or with TURP.

Need for retreatment. Some men who have TUIP later require follow-up treatment with TURP or another prostate
procedure. Treatment is needed either because symptoms return over time or because they never adequately
improve.
How you prepare
Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:

Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your
risk of bleeding several days prior to surgery. These include warfarin (Coumadin), clopidogrel (Plavix), and
nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to
the doctor who prescribed your medication before you make any changes.

Don't eat before your procedure. Your doctor will likely ask you to not eat or drink anything after midnight. On the
morning of your procedure, take only the medications your doctor tells you to with a small sip of water.

Arrange a ride home. You won't be able to drive yourself home after the procedure. You may be able to go home the
day of surgery, or you may need to stay in the hospital overnight. Ask your doctor ahead of time when you can expect
to go home.

Plan for time off work. You may not be able to work or do strenuous activity for several weeks after surgery. Ask
your doctor how much recovery time you may need.
Your doctor may also give you other steps to follow.
What you can expect
TUIP typically takes 20 to 30 minutes. You'll receive either a general anesthetic, which will put you to sleep, or an
anesthetic that blocks feeling from the waist down (spinal block).
During the procedure
Your doctor may put numbing gel inside your urethra and may numb the prostate area with an injection given through
your rectum.
Once the anesthetic is working, your doctor will insert a combined visual and surgical instrument (resectoscope) into
the tip of your penis and extend it to the prostate area. The resectoscope is equipped with a lens or camera, a cutting
device, and valves to release fluid to wash (irrigate) the surgery area. The resectoscope is about 12 inches (30.5
centimeters) long and 1/2 inch (1 centimeter) in diameter. It has a light, valves for controlling irrigating fluid, and an
electrical loop to cut tissue and seal blood vessels. Irrigating fluid is used to lubricate the urethra and rinse away blood.
Using the resectoscope, the doctor makes one or two incisions on the inner surface of the prostate where the bladder
joins the prostate (bladder neck).
After the procedure
You may be able to leave the hospital the day of the procedure, or you may need to stay overnight. Talk to your doctor
about what you can expect, and any precautions you need to take after you go home.

You'll have a catheter in place that enters through the tip of your penis and goes into your bladder to drain your
urine into a collection bag. The catheter may be left in place for one or two days. In some cases, a catheter is needed
for a longer period of time. You may urinate around the catheter, which is normal because your bladder may squeeze
more urine out than the catheter can accommodate. Your doctor may give you disposable catheters you can insert on
your own a few times a day until you can urinate again.

Urination may be painful, or you may have a sense of urgency as urine passes over the surgical area. You may also
need to urinate more often than usual. Painful urination generally improves in one to four weeks.

Expect some blood in your urine right after surgery. If you have clots or so much blood in your urine you can't see
through it, contact your doctor.

Your ability to resume sexual activity depends on how quickly you heal. Talk to your doctor about when it's OK for
you to have sex again. You'll likely be able to resume sexual activity after a few weeks.
These steps can help you recover after your procedure.

Drink plenty of water to flush out the bladder.

Avoid constipation and straining during a bowel movement. Eat fiber-containing foods and avoid foods that can
cause constipation. Ask your doctor if you should take a laxative, if you do become constipated.

Don't take blood-thinning medications until your doctor says it's OK.

Don't do any strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK.
Results

In most men, TUIP improves the ability to urinate and eases related symptoms. It may be a few weeks to
months before you notice the full benefits of treatment.

Your doctor will want to have regular follow-up appointments to check the condition of your prostate and to
discuss any symptom changes.

If the procedure doesn't do enough to lessen your symptoms, you may need to consider additional treatment
steps. A number of men who undergo TUIP need a follow-up procedure to treat prostate enlargement,
particularly after several years have passed.

After TUIP, it's important to have a digital rectal exam once a year to check your prostate and screen for
prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment
to see your doctor.
General anesthesia
http://www.mayoclinic.com/health/anesthesia/MY00100
Definition
General anesthesia is a treatment that renders you unconscious during medical procedures, so you don't feel or
remember anything that happens. General anesthesia is commonly produced by a combination of intravenous drugs
and inhaled gasses (anesthetics).
The "sleep" you experience under general anesthesia is different from regular sleep. The anesthetized brain doesn't
respond to pain signals or surgical manipulations.
The practice of general anesthesia also includes controlling your breathing and monitoring your body's vital functions
during your procedure. General anesthesia is administered by a specially trained physician, called an anesthesiologist,
often in conjunction with a certified registered nurse anesthetist.
Why it's done
Your doctor may recommend general anesthesia for procedures that:

Take a long time

Affect your breathing, such as chest or upper abdominal surgery

Require you to be in an uncomfortable position
Other forms of anesthesia may provide light sedation or use injections to numb a region of your body selectively.
Risks
Most healthy people don't have any problems with general anesthesia. However, as with most medical procedures,
there is a small risk of long-term complications and, rarely, death. Specific complications are related to the type of
procedure and your general physical health.
Additionally, the following factors can increase your risk of complications:

Medical conditions involving your heart, lungs or kidneys

Medications, such as aspirin, that can increase bleeding

Smoking, which increases the likelihood of breathing problems

Alcohol use, which may predispose you to liver damage

Family history of adverse reactions to anesthesia

Food or drug allergies

Sleep apnea

Obesity
The following complications are rare and occur more frequently in older adults or in people who have medical
problems:

Temporary mental confusion

Lung infections

Stroke

Heart attack

Death
Anesthesia awareness
Estimates vary, but about 1 or 2 people in every 1,000 may wake up briefly while under general anesthesia. In most
cases, the person is simply aware of his or her surroundings and doesn't feel any pain. However, some people
experience excruciating pain and develop long-term psychological problems.
The following factors appear to make this phenomenon — also called unintended intraoperative awareness — more
likely:

Emergency surgery

Long-term use of anticonvulsants, opiates, tranquilizers or cocaine

Heart or lung problems

Daily alcohol use
How you prepare

General anesthesia blunts your body's natural inclination to retain food in your stomach and keep it out of your
lungs. That's why it's important to follow your doctor's instructions about when to stop eating and drinking prior
to surgery. In most cases, you should start fasting about six hours before your procedure.

Your doctor may tell you to take certain medications with a small sip of water during your fasting time. You
may need to avoid some medications, such as blood thinners like aspirin, for at least a week before your
procedure. Some vitamins and herbal remedies also keep your blood from clotting normally, so discuss the
types of dietary supplements you take with your doctor.

If you have diabetes, talk with your doctor about altering your diabetes medication during the fasting period.
Usually you will not take oral diabetes medication the morning of surgery, and if you take insulin a reduced
dose will be recommended.

If you have sleep apnea and use a continuous positive airway pressure (CPAP) machine bring it with you to
the surgery. As you awaken from anesthesia the CPAP machine can help you breathe more normally.
What you can expect
Before general anesthesia
Before you undergo general anesthesia, a medical professional specially trained to deliver anesthetics will talk with
you and may ask questions about:

Your health history

Prescription medications, over-the-counter medications and herbal supplements you take

Allergies

Your past experiences with anesthesia
The information you provide will help the anesthesia specialist choose the drugs that will work best and be safest for
you.
During general anesthesia
In most cases, the anesthesia is started with medication delivered through an intravenous line in your arm, but
sometimes it can be started with a gas that you breathe from a mask. For example, children who are afraid of needles
may prefer to go to sleep with a mask. Once you are asleep, a tube may be inserted into your mouth and down your
windpipe to ensure you get enough oxygen and to protect your lungs from blood or body secretions, such as from your
stomach. In some cases this breathing tube isn't needed, which reduces your chance of a sore throat after surgery.
A member of the anesthesia care team monitors you continuously during your procedure, adjusting your medications,
breathing, temperature, fluids and blood pressure as needed. Any abnormalities that occur during the surgery are
corrected by administering additional medications, fluids and, sometimes, blood transfusions.
After general anesthesia
When the surgery is complete, the anesthesia drugs are discontinued, and you gradually awaken either in the
operating room or the recovery room. You'll probably feel groggy and a little confused when you first awaken. Other
common side effects include:

Nausea

Vomiting

Dry mouth

Sore throat

Shivering

Sleepiness