Surgery is recommended for managing BPH in patients with constant acute urinary retention, recurrent urinary tract infections, renal failure, or bladder stones.12 Several surgical options are available:
- Transurethral resection of the prostate (TURP)
- Transurethral incision of the prostate (TUIP)
- Laser surgery
- Open surgery
Transurethral resection of the prostate (TURP) is the gold standard for the surgical
management of BPH. The procedure requires a hospital stay and is performed under
general or spinal anesthesia. In this procedure, a resectoscope containing an electrified
loop is inserted through the penis and used to cauterize prostate tissue and surrounding
blood vessels. The prostate tissue is removed piece by piece. Complications of TURP
include sexual dysfunction, irritative voiding symptoms, bladder neck contraction,
urinary tract infections, hematuria, and dilutional hyponatremia (as a result of
irrigation solution being absorbed into the bloodstream).12
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This outpatient procedure is indicated for patients with smaller prostates (≤30
g resected weight). In TUIP, one or two cuts are made in the prostate and prostatic
capsule, thereby relieving constriction of the urethra. Symptomatic improvement
after TUIP or TURP is comparable.12
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Laser therapies use laser energy to necrotize, resect, or vaporize excess prostate tissue. These procedures include:
Transurethral laser coagulation
In this procedure, the tip of a right-angle laser fiber is held close to the prostate tissue (but not in direct contact with it) and delivers energy at right angles to the fiber. The low-power density energy coagulates the tissue but does not vaporize it. The tissue eventually sloughs off, relieving urethral obstruction. The procedure is associated with low rates of bleeding and water absorption but higher rates of unplanned or prolonged postoperative catheterization and persistence of irritative voiding symptoms.12
Transurethral holmium laser resection/enucleation
In this procedure, the excess prostate tissue is resected using a holmium laser fiber and special resectoscope. Symptom improvement is comparable to TURP but the procedure is associated with a lower risk of bleeding, need for blood transfusions, and absence of dilutional hyponatremia. Laser resection may be an option for men with very large prostates.12
Transurethral laser vaporization
In this technique, the laser tip is kept in direct contact with the prostate tissue
to vaporize it. The procedure results in short-term symptom improvement similar
to that after TURP. However, the rates of unplanned catheterization and postoperative
urinary retention appear to be higher.12
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Open surgery is an option for men with very large prostate volumes (80-100 mL). It involves removal of the inner portion of the prostate via a suprapubic or retropubic incision in the lower abdomen. In rare cases, it may be performed through the perineum.12
Surgical treatment issues
- Surgical procedures for BPH require a hospital stay and are usually performed under general or spinal anesthesia
- Complications such as bleeding, erectile dysfunction, and incontinence are common.
- Irritative voiding symptoms may persist
- Postoperative urinary retention may occur
- Prolonged catheterization may be required
- Retrograde ejaculation may occur in 60% to 99% of patients20
- Complete recovery of sexual function may take up to 1 year4
- Fenter TC, Naslund MJ, Shah MB, et al. The cost of treating the 10 most prevalent diseases in men 50 years of age or older. Am J Manag Care. 2006;12(4 suppl):S90-S98.
- RAPAFLO® (silodosin) Capsules full Prescribing Information, November 2009.
- Marks LS, Gittelman MC, Hill LA, Volinn W, Hoel G. Rapid efficacy of the highly selective α1A-adrenoceptor antagonist silodosin in men with signs and symptoms of benign prostatic hyperplasia: pooled results of 2 phase 3 studies. J Urol. 2009;181:2634-2640.
- National Institute of Diabetes and Digestive and Kidney Diseases. Prostate enlargement: benign prostatic hyperplasia. NIH Publication No. 07-3012. June 2006.
- Bruskewitz RC. Quality of life and sexual function in patients with benign prostatic hyperplasia. Rev Urol. 2003;5:72-80.
- Roberts RO, Jacobsen SJ, Rhodes T, et al. Natural history of prostatism: impaired health status in men with lower urinary tract symptoms. J Urol. 1997;157:1711-1717.
- Atlas of Human Anatomy, Frank H. Netter, MD, Ciba-Geigy Corporation, Summit, NJ, 1989.
- Data on file, Watson Laboratories, Inc.
- Marks LS, Gittelman MC, Hill LA, Volinn W, Hoel G. Silodosin in the treatment of the signs and symptoms of benign prostatic hyperplasia: a 9-month, open-label extension study. Urology. 2009;74:1318-1322.
- Agency for Healthcare Quality and Research (U.S. Dept Health and Human Services): Quick Tips When Talking With Your Doctor. Available at: http://www.ahrq.gov/consumer/quicktips/doctalk.htm. Accessed July 28, 2010.
- American Urological Association. AUA guideline on management of benign prostatic hyperplasia (2003). Chapter 1: Diagnosis and treatment recommendations. J Urol. 2003;170:530-547.
- Fagelman E, Lowe FC. Herbal medications in the treatment of benign prostatic hyperplasia (BPH). Urol Clin N Am. 2002;29:23-29, vii.
- National Institute on Aging: Talking With Your Doctor: A Guide For Older People. NIH Publication No. 05-3452. August 2005 (Reprinted April 2010). Available at: http://www.nia.nih.gov/NR/rdonlyres/90DF996C-DF5F-4245-B7CA-B2E1B993D8C7/0/TWYD_0521_web.pdf. Accessed July 29, 2010.
- Medline Plus Medical Encyclopedia from NIH: Enlarged Prostate. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000381.htm. Accessed July 29, 2010.
- Shvartzman P, Borkan JM, Stoliar L, et al. Second-hand prostatism: effects of prostatic symptoms on spouses’ quality of life, daily routines and family relationships. Family Pract. 2001;18:610-613.
- Kuritzky L. A primary care physician’s perspective on benign prostatic hyperplasia. Rev Urol. 2003;5(suppl 5):S42-S48.
- Wolters R, et al: Lower urinary tract symptoms: social influence is more important than symptoms in seeking medical care. BJU Int. 2002;90:655–661.
- Rosen RC, Giuliano F, Cason CC. Sexual dysfunction and lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Eur Urol. 2005;47:824–837.
- Ponholzer A, Madersbacher S. Lower urinary tract symptoms and erectile dysfunction; links for diagnosis, management and treatment. Int J Impot Res. 2007;19:544-550.
- MacDiarmid SA, Hill LA, Volinn W, Hoel G. Lack of pharmacodynamic interaction of silodosin, a highly selective α1a-adrenoceptor antagonist, with the phosphodiesterase-5 inhibitors sildenafil and tadalafil in healthy men. Urology. 2010;75:520-525.
- Marks LS. Reply to editorial comment. Urology. 2009;74:1323-1324.
- Schwinn DA, Roehrborn CG. α1-Adrenoceptor subtypes and lower urinary tract symptoms. Int J Urol. 2008;15:193-199.
- Straus SM, Kors JA, De Bruin ML, et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults. J Am Coll Cardiol. 2006;47:362-367.
- Carbone DJ, Hodges S. Medical therapy for benign prostatic hyperplasia: sexual dysfunction and impact on quality of life. Int J Impot Res. 2003;15:299-306.
- Nomiya M, Yamaguchi O. A quantitative analysis of mRNA expression of alpha 1 and beta-adrenoceptor subtypes and their functional roles in human normal and obstructed bladders. J Urol. 2003;170(2 Pt 1):649-653.
- Murata S, Taniguchi T, Takahashi M, et al. Tissue selectivity of KMD-3213, an α1-adrenoreceptor antagonist, in human prostate and vasculature. J Urol. 2000;164:578-583.
- Stafford-Smith M, Bartz R, Wilson K, et al. Alpha-adrenergic mRNA subtype expression in the human nasal turbinate. Can J Anesth. 2007;54:549-555.
- Wei JT, Calhoun E, Jacobsen SJ. Urologic Diseases in America Project: benign prostatic hyperplasia. J Urol. 2008;179(5 Suppl.):S75-S80.
- Issa MM, Regan T. Medical therapy for benign prostatic hyperplasia—present and future impact. Am J Manag Care. 2007;13:S4-S9.
- Berry SJ, Coffey DS, Walsh PC, et al. The development of human benign prostatic hyperplasia with age. J Urol. 1984;132:474.
- Nickel JC. Comparison of clinical trials with finasteride and dutasteride. Rev Urol. 2004;6 Suppl 9:S31-39.
- Hernández C, Estivill E, Prieto M, et al. Nocturia in Spanish patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Curr Med Res Opin. 2008;24:1033-1038.
RAPAFLO® is indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). RAPAFLO® is not indicated for the treatment of hypertension.
RAPAFLO® is contraindicated in patients with severe renal impairment (CCr <30 mL/min), severe hepatic impairment (Child-Pugh score ≥10), and with use of strong CYP3A4 inhibitors. Postural hypotension with or without symptoms (eg, dizziness) may develop when beginning treatment with RAPAFLO®. As with all alpha-blockers, there is a potential for syncope. Patients should be warned of the possible occurrences of such events and should avoid situations where injury could result. RAPAFLO® should be used with caution in patients with moderate renal impairment. Patients should be assessed to rule out the presence of prostate cancer prior to starting treatment with RAPAFLO®. Patients planning cataract surgery should inform their ophthalmologist that they are taking RAPAFLO®.
The most common side effects are retrograde ejaculation, dizziness, diarrhea, orthostatic hypotension, headache, nasopharyngitis, and nasal congestion.