For severe benign prostatic hyperplasia treatments, surgery is often the answer and usually requires complete removal of the enlarged prostate. There are several surgical options. Most of these options are performed in the hospital setting, although some laser procedures can be done comfortably in the office. Dr Kella has performed all the procedures below.
Transurethral resection of the prostate (TURP), the most common procedure, involves inserting a scope into the penis to reach the prostate and remove it in small pieces. TURP is being replaced by newer procedures such as Thullium, Holmium, and Green-light laser therapy for enlarged prostate. The laser allows tissue to be vaporized. There is minimal bleeding during a laser procedure. Some patients may still need to spend a night in the hospital. Usually the catheter can be removed after 24 hours. The laser offers the advantage of minimal char. This allows for faster healing and less irritative side effects. Less than 1% of men experience sexual dysfunction after laser therapy. Nearly a third will have problems with a lack of ejaculation (retrograde ejaculation). Laser therapy allows you to return to work in a few days. Strenuous activity should be avoided for approximately 4 weeks. Clinical studies show that laser therapy can offer rapid and lasting relief lasting for at least 5 years. Most patients will have some slight burning for a week or so after the procedure. This can be managed with mild pain and anti-inflammatory medication.
Another form of TURP is a bipolar TURP. With the bipolar, we use a “button” which creates a plasma that vaporizes tissue. The button TURP also has less bleeding vs a conventional TURP, usually. With all these surgeries, the flow rate is improved much more with surgery compared to oral medications. For the first few weeks, symptoms may actually be worse as the tissue can actually swell from the inflammation and eventual healing associated with treatment. The restrictions and results of the button turp are similar to laser therapy for enlarged prostate.
Transurethral incision of the prostate (TUIP) for enlarged prostate. The urologist makes a small incision in the prostate tissue to widen the opening between the urethra and bladder outlet.
Simple Prostatectomy. An open surgery to remove the inner part of the enlarged prostate gland. The robot can be used to perform this procedure. This allows for a faster recovery than a conventional open surgery. Read about robotic surgery and the importance of experience