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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