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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
  • Medication
  • 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 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.

Read below for more information on laser treatments available at Spire Thames Valley Hospital.

Greenlight laser for prostate surgery

Spire Thames Valley Hospital is able to offer Greenlight laser treatment – an innovative, non-invasive procedure which is revolutionising the treatment of the enlarged prostate medically known as benign prostatic hyperplasia (BPH).

Many patients can return home within 24 hours

Previously the standard treatment for benign prostatic hyperplasia (BPH) was transurethral resection of the prostate (TURP). Now, the latest developments in laser treatment have reduced invasiveness and are proving more effective.

How does it work?

Just as in TURP, some prostate tissue is removed in order to relieve pressure on the urethra. But this time a laser probe is inserted and under the guidance of the surgeon the overgrown tissue is vaporised by the laser energy. The laser very effectively stops any tissue from bleeding and as a result no bladder irrigation is required.

Side-effects are similar to those of TURP. But with much less bleeding, the laser procedure is considered less invasive. Typically this means the hospital stay is shorter and recovery faster. However it is not uncommon for patients to feel a burning/stinging sensation for some time after the procedure and this may last up to six or even eight weeks.

It is normal to have traces of blood in the urine after this operation, so it is advisable to drink plenty of water for a few days while it clears. Clots are sometimes passed 10-14 days afterwards; again, this is part of the healing process.

Apart from this and the risk of infection that accompanies any operation or invasive procedure, the only significant side-effect is the near certainty that normal ejaculation will cease. This is because the contraction that occurs during orgasm may not completely block the entrance to the bladder once some tissue has been removed, and the semen will flow back into the bladder ('retrograde' or 'dry' ejaculation) rather than out through the penis. This is not harmful, but it does mean that future fertility is greatly reduced.

Alongside our highly experienced surgeons, Spire Thames Valley Hospital prides ourselves in providing a high standard of pre- and post-operative care with outstanding clinical facilities for both day cases and overnight stays.

If you are interested in knowing more about the benefits of laser prostate treatments at the Spire Thames Valley Hospital then please use one of the options under To contact us below.

Holmium laser enucleation of the prostate

Spire Thames Valley Hospital is delighted to be able to offer a modern alternative to the standard TURP, a Holmium Laser Enucleation of the prostate (HoLEP). It is fully endorsed by the National Institute of Clinical excellence (NICE) in the UK for the treatment of urinary symptoms or bladder outflow obstruction due to benign prostatic hyperplasia (BPH).

It requires a short in-patient stay and a general anaesthetic. A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to avoid straining or heavy lifting for four weeks after the surgery.

Who is it suitable for?

HoLEP can be performed on men of any age with urinary symptoms caused by an enlarged prostate. It is particularly indicated in men with large prostates (over 60cc in size) and men on medications to thin the blood such as warfarin, aspirin or clopidogrel.

What are the advantages of HoLEP?

  • There is no upper size limit of prostate that can be dis-obstructed – traditionally men with prostates over 100cc in size needed major open surgery
  • There is less bleeding than after a TURP
  • Discharge is usually quicker than after TURP often the next morning
  • The chance of recurrence requiring further surgery is very lower than a TURP
  • Unlike greenlight laser operations, large quantities of prostate tissue are sent for pathological analysis
  • The PSA (blood test) generally drops to very low levels after HoLEP operations

What are the disadvantages of HoLEP?

The procedure takes slightly longer than a TURP and requires specialist training.

How does it work?

The aim of the HoLEP operation is to relieve pressure on the tube through which the urine drains (urethra) by anatomically enucleating the majority of excess benign prostate tissue. This is done under a general anaesthetic with the help of a telescopic camera inserted through the penis. The three lobes of the prostate that are cored out intact are pushed into the bladder before being sucked up (morcellated) by a special instrument inserted through the telescopic camera. The pieces are sent for laboratory analysis just in case they might be found to be cancerous. A catheter is placed into the bladder to drain the urine while the raw surface heals, then left in place for around 24 hours before being removed on the day of discharge from hospital. Sterile saline fluid may be irrigated into the bladder through the catheter to dilute any blood in the urine and prevent clots from forming but is often not required.

It is normal to have some blood in the urine after this operation, so it is advisable to drink plenty of water for a few days while it clears. Clots are sometimes passed 10-14 days afterwards; again, this is part of the healing process.

Apart from this and the risk of infection that accompanies any operation or invasive procedure, it is important to be aware that normal ejaculation ceases in 70% of patients. This is because the contraction that occurs during orgasm may not completely block the entrance to the bladder once some tissue has been removed, and the semen will flow back into the bladder ('retrograde' or 'dry' ejaculation) rather than out through the penis. This is not harmful, but it does mean that future fertility is greatly reduced. The procedure has a very low risk of of affecting erectile function or continence, although the urinary symptoms may take a few weeks to settle down afterwards.

Alongside our highly experienced surgeons, At Spire Thames Valley Hospital we pride ourselves in providing a high standard of pre- and post-operative care with outstanding clinical facilities for both day cases and overnight stays.

If you are interested in knowing more about the benefits of laser prostate treatments at the Spire Thames Valley Hospital then please use one of the options under To contact us below.

Our specialist team

Meet the consultant urologists who are part of our men's health team at Spire Thames Valley Hospital.

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