What is prostate enlargement or Benign Prostate Hyperplasia (BPH)?
It’s common for the prostate gland to enlarge as men get older. The condition is known as benign prostatic hyperplasia (BPH). This is benign and there is no evidence that it leads to cancer. In some cases, it becomes large enough to put pressure on the urethra (the tube that carries urine out of the penis). This can cause problems with urination, such as frequent trips to the toilet, including having to get up several times in the night, and dribbling of urine.
What treatments are available for BPH?
- Watchful waiting
- Microwave and heat therapies
- Conventional surgery - TURP or Transurethral Resection of the Prostate
- Laser surgery - e.g. Holmium laser enucleation (HoLEP) or Green Light laser
What is involved in prostate surgery?
Prostate surgery is an operation to remove some or most of an enlarged prostate gland so that urine can flow more freely. Prostate surgery is usually performed under general anaesthesia, which means that you will be asleep during the procedure. However, for some men, epidural or spinal anaesthesia is preferable. This completely blocks the feeling in your pelvis and legs, but you will still be awake. Your surgeon and anaesthetist will discuss which type of anaesthesia is most suitable for you.
What is TURP?
A transurethral resection of the prostate, or TURP for short, involves a thin, tube-like telescope called a resectoscope, which is put into the opening of your penis and passed up the urethra towards the prostate. An attachment at the end of the resectoscope is used to cut away part of the prostate using electrical energy. There are no stitches or dressings after this operation.
The operation lasts for about an hour. Afterwards, a catheter is inserted to allow urine to flow freely. This is a thin, sterile tube that is inserted through the urethra and into your bladder. TURP usually involves a hospital stay of up to five days. Your surgeon will explain the benefits and risks of having TURP and will also discuss the alternatives to the procedure.
TURP is a commonly performed and generally safe operation. However, all surgery carries risks as well as benefits. Most men find that a lasting side-effect of a TURP is dry orgasm (retrograde ejaculation), which happens because semen can travel back up into the bladder rather than out through the penis. This should not interfere with sex and after recovery from the operation, most men return to the same level of sexual activity as before the treatment. However, this may affect your ability to father children through sexual intercourse.
Rarely it is possible to have some long-term urinary incontinence or problems emptying your bladder, even after the initial recovery period. The chance of complications depends on the exact type of operation you are having and other factors, such as your general health. Ask your surgeon to explain how any risks apply to you.
What is laser prostate surgery?
Laser prostate surgery is a treatment using high powered laser energy (eg: HoLEP Holmium laser or GreenLight laser) to remove or enucleate obstructive prostatic tissue or vaporise tissue with the aim of leaving a wide channel and restoring normal urinary function. Under anaesthesia a small flexible fibre-optic is inserted into the urethra. Light pulses are then sent through this fibre, to cut away the obstructing prostatic tissue which is removed from the bladder with a morcellator. There is minimal bleeding or pain after the procedure.
The procedure takes around 60-90 minutes and is performed under general or spinal anaesthesia. You may be allowed to return home on the same day, but sometimes an overnight stay will be required. You can generally be discharged once you are emptying your bladder satisfactorily.
Strenuous activity should be avoided for two weeks and patients generally return to work about five days after surgery.
What are the benefits of laser prostate surgery?
The two most widely reported benefits of laser surgery are reduced risk of bleeding (compared to TURP) and shorter hospital stay. Most patients can expect a rapid improvement in their urinary flow rate, and a quick return to normal activities following the procedure. Laser surgery is also associated with lower risks of sexual and other side-effects common with TURP.