Laser Surgery For An Enlarged Prostate Is No More Effective Than Standard Surgery
This is a plain English summary of an original research article
Two procedures to treat men with enlarged prostates are both effective, new research has shown.
A benign enlarged prostate is not cancer and is not usually a serious threat to health. But it is common in men over 50 and some need surgery to treat troublesome urinary symptoms caused by the growing prostate. The most common procedure is transurethral resection of the prostate which is usually successful but can lead to complications such as bleeding in some men.
The UNBLOCS trial compared the effectiveness of TURP to a new laser procedure which might reduce a patients hospital stay and cause fewer side effects. The thulium laser, ThuVARP, vaporises excess prostate. Men who needed a prostate operation were asked to consent to either procedure without knowing which one they would receive.
One year later, men in both groups were satisfied with their surgery. They reported similar improvements in their urinary symptoms and quality of life. There was no difference between the two procedures in terms of hospital stay or complications. However, men in the TURP group achieved a faster urinary flow rate . TURP was also slightly more cost-effective and faster to perform than the laser procedure.
Innovations In Treatment Of Bph
New procedures are less invasive than many older choices, with good results and comfortable recovery.
Although there is no cure for benign prostatic hyperplasia , also known as enlarged prostate, there are many useful options for treating the problem. Treatments focus on prostate growth, which is the cause of BPH symptoms. Once prostate growth starts, it often continues unless medical therapy is started. The prostate grows in two different ways. In one type of growth, cells multiply around the urethra and squeeze it, much like you squeeze a straw. The second type of growth is middle-lobe prostate growth in which cells grow into the urethra and the bladder outlet area. This type of prostate growth typically requires surgery.
The first line of care for treating BPH is often medication. Doctors may prescribe an alpha blocker to relax the prostate, a 5-alpha reductase inhibitor to reduce the prostate’s size, or both. While medications are helpful for many patients, some may impact a man’s sexual function or only reduce, not eliminate symptoms if the patient has a moderate to severe case of BPH.
In cases where patients have moderate to severe BPH or have a middle-lobe growth and need further treatment, there are a range of BPH-related surgical procedures, including ones that are less invasive than older surgeries. A patient and his doctor will choose the best option based on the size and shape of the prostate, as well as the patient’s preference and overall medical condition.
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Are There Side Effects From Having A Urinary Catheter
Yes, there can be side effects or unwanted changes in your body when you use a urinary catheter. Side effects are different from person to person. Some people have no or very mild side effects. The good news is that there are ways to deal with most of the side effects. There are several side effects that you may have if you have a urinary catheter. They are bladder spasms, blood in your urine, and infections.
Urinary tract infections. Infections of the urinary tract are very common. An infection is when germs enter your body causing you to have a fever or pain, redness, and swelling in one part of your body. To lower your risk of getting an infection:
How Is Prostate Surgery Performed
Surgeons perform prostate resections to remove only part of the prostate gland when it is enlarged. These are minimally invasive procedures with no incisions in your skin. They are often done with local anesthetic or regional anesthesia, although you may require general anesthesia. If you have a local anesthetic or regional block, you will also receive a sedative to relax you during the procedure.
Here are the different prostate resection procedures:
Surgeons perform prostate removal surgeries while you are under general anesthesia in a hospital operating room. There are several approaches your surgeon may choose from, depending on your diagnosis and overall health:
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Prostate Surgery With Urology Specialist
Dr Arianayagam is highly experienced in all aspects of prostate surgery, in particular robotic radical prostatectomy.
Dr Arianayagam performs robotic radical prostatectomy at both Macquarie University Hospital and Nepean Public Hospital. Dr Arianayagam has performed over 250 robotic cases. He is a proctor for Device Technologies, who supply the Da Vinci Robotic System in Australia. Being a proctor means Dr Arianayagam is qualified to teach other surgeons to use this technique.
If you have any questions regarding prostate surgery, or would like to book an appointment, please feel free to contact Urology Specialist here.
How Turp Is Performed
TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts need to be made in your skin.
The loop of wire is then heated with an electric current and used to cut away the section of your prostate causing your symptoms. A thin tube called a catheter is then inserted into your urethra to pump fluid into the bladder and flush away pieces of prostate that have been removed.
General or spinal anaesthesia is used during the procedure so you don’t feel any pain while it’s carried out.
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How Well Does Surgery Work
The American Urological Association symptom index helps you describe how bad your symptoms are. This index can also be used to measure how well various treatments might work for your symptoms. But the most important thing is how much the symptoms bother you.
TURP
Symptoms get better for more than 70 out of 100 men who have this surgery.footnote 1
Men who are very bothered by their symptoms are most likely to notice great improvement. Men who are not very bothered by their symptoms are less likely to notice a big change.
What Are Other Benign Prostatic Hyperplasia Surgery Options
If your symptoms are severe or minimally invasive surgical treatments dont help with your enlarged prostate, your doctor will likely recommend another kind of surgery. Other prostate procedures include:
Transurethral resection of the prostate : This is the most common treatment for BPH. During this procedure, your urologist will insert a rigid instrument called a resectoscope into the urethra. This is why it is called transurethral. Inserting the scope this way means no cutting into the prostate. They will then use the charged resectoscope to remove the excess tissue that is blocking the urine from leaving the bladder.
You may be put to sleep with general anesthesia. Local anesthesia for the lower part of the body may be used for this procedure. The average in hospital stay for TURP is 1 to 2 days.
Transurethral incision of the prostate : This is a similar procedure to TURP. Instead of prostate tissue being removed the bladder neck and prostate are cut to relax the bladder opening, allowing urine to flow more freely. TUIP is most successful on men with smaller prostates.
Simple prostatectomy: This method is a surgical procedure in which an incision is made through the abdomen or performed laporoscopically. The inner portion of the prostate gland is removed, leaving the outer segment intact.
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How Does Holep Treat Bph
Holmium laser enucleation of the prostate is a type of laser surgery used to treat the obstruction of urine flow as a result of benign prostatic hyperplasia. The holmium laser is a surgical laser that has been found particularly effective in performing several types of urological surgeries. In the case of HoLEP, the laser is used to cut and remove the bulky prostate tissue that is blocking the flow of urine.
Patients who are appropriate for HoLEP are typically symptomatic due to very large prostates. Patients may not be candidates for HoLEP if they have bleeding problems or have had certain types of prior prostate treatments.
HoLEP requires the patient to be under general anesthesia. If a patient cannot have general anesthesia for some reason, a spinal anesthetic can be usedthis allows him to remain awake but blocks all feeling from the waist down.
A surgical instrument called a resectoscope is inserted through the urethra. The resectoscope includes a camera that allows the surgeon to view the internal structure of the prostate gland, and to see where incisions are being made during surgery.
The laser is inserted into the resectoscope and is used to enucleate the enlarged prostate tissue from the outer shell of the prostate, and then to seal up any blood vessels. The tissue that has been removed is deposited in the bladder. When tissue removal is complete, the resectoscope is withdrawn and a urinary catheter is put in place.
The Different Types Of Prostate Surgery
Prostatectomy
The term prostatectomy is used to describe a number of different surgical procedures to remove either part or all of the prostate gland. This may be required to treat prostate cancer or BPH.
When only a part of the prostate is removed, this is called a simple prostatectomy. This process involves enucleating it from its capsule to trim away excess tissue, but where the sphincter muscle and nerves remain intact. It is usually used to treat BPH, which is a benign condition, meaning there is no risk of malignant cells having moved on to surrounding tissue.
When the entire prostate gland, capsule , the surrounding lymph nodes and neighbouring tissue is removed, this is known as a radical prostatectomy. This is usually a treatment for men with localised prostate cancer and there a number of techniques used:
Open Surgery This is where the prostate is removed via a large single incision in the lower abdomen, or the perineum .
Laparoscopic Radical Prostatectomy This is where the prostate is removed via several small incisions in the lower abdomen using small surgical instruments. This process is much less invasive than open surgery.
Robotic-assisted radical prostatectomy Much like laparoscopic radical prostatectomy, the prostate is removed via small incisions in the lower abdomen. Robotic-assisted instruments are inserted through the incisions and controlled by a surgeon.
Holmium Laser Enucleation of the Prostate
Transurethral Resection of the Prostate
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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.
An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.
Why The Procedure Is Performed
An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your doctor may tell you changes you can make in how you eat or drink. You may also try some medicines.
Your doctor may recommend prostate removal if you:
- Cannot completely empty your bladder
- Have repeat urinary tract infections
- Have bleeding from your prostate
- Have bladder stones with your enlarged prostate
- Urinate very slowly
- Took medicines and they did not help your symptoms
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Side Effects Of Prostate Surgery
The major possible side effects of radical prostatectomy are urinary incontinence and erectile dysfunction . These side effects can also occur with other forms of prostate cancer treatment.
Urinary incontinence: You may not be able to control your urine or you may have leakage or dribbling. Being incontinent can affect you not only physically but emotionally and socially as well. These are the major types of incontinence:
- Men with stress incontinence might leak urine when they cough, laugh, sneeze, or exercise. Stress incontinence is the most common type after prostate surgery. It’s usually caused by problems with the valve that keeps urine in the bladder . Prostate cancer treatments can damage this valve or the nerves that keep the valve working.
- Men with overflow incontinence have trouble emptying their bladder. They take a long time to urinate and have a dribbling stream with little force. Overflow incontinence is usually caused by blockage or narrowing of the bladder outlet by scar tissue.
- Men with urge incontinencehave a sudden need to urinate. This happens when the bladder becomes too sensitive to stretching as it fills with urine.
- Rarely after surgery, men lose all ability to control their urine. This is called continuous incontinence.
After surgery for prostate cancer, normal bladder control usually returns within several weeks or months. This recovery usually occurs slowly over time.
There are several options for treating erectile dysfunction:
Why Turp Is Carried Out
TURP is often recommended when prostate enlargement causes troublesome symptoms and fails to respond to treatment with medication.
Symptoms that may improve after TURP include:
- problems with starting to pee
- a weak flow of pee, or stopping and starting
- having to strain to pee
- a frequent need to pee
- waking up frequently during the night to pee
- a sudden urge to pee
- being unable to empty your bladder fully
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Personal Stories About Using Surgery For Benign Prostatic Hyperplasia
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
Over the past year, I’ve started to feel like my life revolves around the bathroom. I have to go every 2 or 3 hours, and in my line of work, that’s a real inconvenience. And then sometimes it takes me 5 or 10 minutes to finish. It’s become a real annoyance to me. I tried medicines to relax and shrink my prostate. But I didn’t like the side effects, and I don’t want to be on medicine for the rest of my life. This surgery sounds like a good option for me. I think I can manage the possible side effects of the surgery a lot better than the symptoms I have now. It makes sense to me to take care of the problem and not just treat the symptoms.
John, age 56
I’ve adapted pretty well to the changes in my urination. Instead of standing there waiting for something to happen, I just have a seat, pick up a magazine, and let nature take its course. Some men might have a problem with that, but I’m retired and I don’t find it a bother at all. I don’t feel any need to have surgery, because I think I’m managing just fine. Who knows whether the risks of surgery might not be worse than what I’m dealing with now?
Geraldo, age 67
Tom, age 70
Dave, age 65
When Is Bph Treatment Necessary
The course of BPH in any individual is not predictable. Symptoms, as well as objective measurements of urethral obstruction, can remain stable for many years and may even improve over time for as many as one-third of men, according to some studies. In a study from the Mayo Clinic, urinary symptoms did not worsen over a 3.5-year period in 73% of men with mild BPH. A progressive decrease in the size and force of the urinary stream and the feeling of incomplete bladder emptying are the symptoms most correlated with the eventual need for treatment. Although nocturia is one of the most annoying BPH symptoms, it does not predict the need for future intervention.
If worsening urethral obstruction is left untreated, possible complications are a thickened, irritable bladder with reduced capacity for urine infected residual urine or bladder stones and a backup of pressure that damages the kidneys.
- Inadequate bladder emptying resulting in damage to the kidneys
- Complete inability to urinate after acute urinary retention
- Incontinence due to overfilling or increased sensitivity of the bladder
- Recurrent severe hematuria
- Symptoms that trouble the patient enough to diminish his quality of life
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What Are The Risks
In most cases, TURP is a safe procedure and the risk of serious complications is very small.
Some men also lose the ability to control their bladder , although this usually passes in a few weeks. In rare cases, it may be persistent and need further treatment.
There’s also a small risk of problems such as erectile dysfunction, difficulties passing urine and urinary tract infections .