Prostate surgery and laser prostate surgery

During surgery, your surgeon will remove part of your prostate – a small gland that sits at the base of the bladder in men. The gland surrounds your urethra – the tube that carries urine from your bladder to your penis.

An enlarged prostate, also known as benign prostatic hyperplasia (BPH), is a common condition in older men and the causes are thought to relate to age and changes in hormone level, with older age and family history increasing the risk. 

If you have an enlarged prostate, it can press on your bladder and urethra, interrupting urine flow and causing these symptoms:

• Difficulty starting to pass water
• Feeling that you haven’t emptied your bladder properly
• A weak flow of urine that stops and starts
• Needing to strain to pass water
• Needing to go to the loo a lot, especially at night
• Getting sudden urges to pass water

Other complications due to blocked urine flow may include:

• Recurring urinary tract infections (UTIs)
• Kidney or bladder damage
• Bladder stones
• Haematuria (blood in your urine)

Your doctor may recommend treatment or refer you to a urology specialist if you have moderate to severe urinary problems which haven’t improved with:

• Lifestyle changes to manage urine flow
• Medication to shrink your prostate, relax your prostate or bladder muscles, or to manage urine flow

The treatment will trim away or destroy the obstructive prostate tissue that’s pressing on your bladder and urethra, easing symptoms.

Your consultant will diagnose a prostate enlargement by asking about your symptoms and carrying out tests, which may include:

• A physical examination of your back passage, stomach and genitals
• Blood and urine tests to rule out other causes such as infections, kidney disease or prostate cancer

There are several methods available for prostate surgery.

TURP

The standard method is transurethral resection of the prostate (TURP). During a TURP procedure, which is usually performed under general anaesthetic, your surgeon will:

• Insert a resectoscope (a long, thin, metal tube with a telescopic camera and light) through your penis into your urethra and bladder
• Pass a small, electrically-heated wire loop through the resectoscope
• Trim small central pieces of prostate tissue using the wire loop to create a channel where urine can easily pass through, and extract the pieces by suction
• Insert a thin tube called a catheter through your penis and into your urethra
• Use the catheter to flush out any blood clots, urine or remaining prostate tissue from your bladder using a saltwater solution
• The catheter will remain in place for around one to three days after the operation

TURP may also be performed to treat or prevent any further complications as a result of blocked urine flow, including recurring UTIs, kidney and bladder damage, bladder stones, blood in the urine and difficulties in urination.

Laser prostate surgery

With laser prostate surgery, your surgeon will follow the same steps as TURP, but instead of using a resectoscope with an electrically-heated wire to cut away your prostate, they’ll use a scope which has a special laser (eg a HoLEP Holmium laser or GreenLight laser). The laser generates precise and intense heat to cut away sections of your enlarged prostate.

UroLift

UroLift is a procedure where instead of removing prostate tissue, prostatic urethral lift (PUL) implants are positioned to hold your prostate out of the way and increase the width of your urethra. This procedure can be performed under general or local anaesthetic, a urinary catheter is not usually required.

Prostate artery embolisation (PAE)

PAE shrinks the size of your prostate by blocking the arteries that feed it. It’s a minimally invasive technique which is usually performed by an interventional radiologist using local anaesthetic. A urinary catheter is not usually required and you’ll need to let your doctor know if you have any allergies or have previously reacted to an intravenous contrast medium.

Transurethral resection or vaporisation of the prostate (TUVP)

A thin tube, known as a cystoscope, is inserted into the urethra and a laser attached to the end targets energy to cut or burn away prostate tissue.

While TURP is probably still the gold standard for prostate surgery, these alternative, less invasive or non-surgical methods can provide benefits to some patients. These may include:

• Fewer side effects such as a lower risk of bleeding – non-surgical methods may be preferred for men who take medication that affects blood clotting properties
• A shorter hospital stay – these treatments can usually be done with just a single overnight stay at the hospital
• A quicker recovery – recovery from less invasive and non-surgical methods generally takes less time than TURP
• A catheter is needed for less time or not at all – a TURP procedure will require you to have a catheter for around two days

Who will be involved?

As well as your chosen surgeon, you’ll also be seen by an anaesthetist who will administer anaesthetic during the operation.

Preparing for prostate surgery

You may be asked to attend a consultation a couple of weeks before your operation is due. Here, you might undergo some blood or other tests to help check your fitness for surgery. During this pre-operative assessment, you’ll also have to inform us of any medication you are currently taking.

If you are a smoker, you should try and cut down in the build-up to your operation, this can reduce your risk of complications including chest infections and blood clots.

You may be asked to stop taking medication several days before your surgery, such as blood thinners. Your doctor may also prescribe you an antibiotic to reduce your risk of getting a urinary tract infection.

On the day of your surgery, you’ll have to stop eating around six hours before the procedure, but you can drink clear fluids until two hours before. You may also be given some compression stockings to prevent any blood clots forming during surgery.

How long does the procedure take?

It’s usually between 45 minutes and two hours, depending on the size of your prostate and the technique used.

Anaesthetic choices

Your consultant will advise on what’s best for you, based on your health and personal preferences. It will either be:

• A general anaesthetic, when you’re asleep
• A spinal or epidural anaesthetic, when you’re awake but can’t feel anything below your waist
• A local anaesthetic so the treatment area will be numb

Pain after surgery

It’s normal to feel some discomfort afterwards and if you have a catheter, you may experience some bladder spasms from the catheter rubbing against your bladder wall, but you shouldn’t have any extreme pains. Everyone experiences pain differently and you’ll be given medication to help you manage this.

Your hospital stay

For a TURP procedure, you’ll need to stay in hospital for between one and three nights, you’ll be able to go home once your catheter is removed. For laser prostate surgery, you may be able to go home on the same day, though many people stay in hospital for the night. For UroLift or PAE you can usually go home on the same day. All patients will be given advice about recovery and a date for a follow-up appointment, this is usually a few weeks after your procedure.

Recovery timeline

We aim to get you back to everyday life as quickly as possible, although everyone’s different and your treatment and recovery will be personal to you. If you have a catheter,  you can expect to return home once it has been removed, this is usually within three days. You can expect to resume driving and gentle activities such as walking after one to three weeks of recovery, though you should always stop if you start to feel any pain. You may also be able to go back to work if you have a desk-based job and you should be able to have sex if you’re comfortable enough. A full recovery can take anywhere between four to eight weeks.

Urinating after TURP

After TURP, you’ll be unable to urinate as your urethra will be swollen. You’ll need to use a catheter until the swelling has gone down, this is usually around two days after your procedure, but it can be a little longer if you are still having difficulties. You may find it painful and difficult to control the flow at first, but this will get better after a few days.

Your lifestyle after treatment

For TURP and laser prostate surgery, you’ll have a catheter which will be left in place for one to three days until swelling in your urethra has gone down. Once you can pass water normally, you can go home.

When you're ready to leave hospital, you’ll need to arrange for someone to collect you and you may want them to stay with you for the first 24 hours. After treatment, it’s normal to experience these temporary symptoms:

• Mild burning and discomfort on passing water
• Needing to pass water frequently or urgently
• Occasional blood in your urine for the first couple of weeks
• Tiredness
• Constipation

It’s advised that you drink lots of water during your recovery to help reduce your risk of getting a urinary tract infection (UTI) and it also helps clear out any blood in your urine. Your doctor may also recommend eating foods high in fibre to avoid constipation, and pelvic floor exercises to improve your bladder control.

You can do gentle exercise such as walking when you feel up to it, but you shouldn’t lift heavy objects, including shopping, for the first three to four weeks. You may want to arrange help with everyday tasks.

It will usually be three to four weeks before you can return to work, but this largely depends on your job. If your work is physically strenuous, you may need longer to recover from your surgery – your consultant will advise you. Check with your consultant before you start driving again, you’ll be safe to do so as soon as you can perform the emergency stop manoeuvre comfortably. It’s also advisable to check with your motor insurance company. Most people can get back to all normal activities by eight weeks and feel comfortable enough to have sex after around four weeks.

You may have to wait before returning to any medications that affect how your blood clots, your consultant will discuss this with you.

The recovery time for laser prostate surgery, UroLift or PAE may be quicker than for TURP.

Most people have prostate surgery without complications, but all surgery carries some risks. Your consultant will explain them to you before you go ahead.

Prostate surgery complications can include:

• Retrograde ejaculation, when you don’t produce semen when you orgasm – it’s not harmful but may affect fertility
• Needing the loo urgently
• Difficulty getting and maintaining an erection
• Narrowed urethra, causing urinary problems such as difficulties holding urine
• Bleeding
• Urinary tract infection
• Need for re-treatment
• Low sodium levels in the blood

With TURP, there is also a risk of TURP syndrome, associated with the irrigation fluid required to flush out the cut-away parts of your prostate. TURP syndrome needs urgent medical treatment. Symptoms include:

• Nausea and sickness
• Slow heartbeat
• Dizziness
• Headache
• Swollen abdomen

At Spire hospitals, your safety is our top priority. We have high standards of quality control, equipment and cleanliness and a rigorous system of review and training for our medical teams.