Endo-urological surgeries for prostate enlargement

The prostate gland is a male reproductive organ which is situated below the bladder and in front of the rectum. The most important function of this gland is to produce ejaculatory fluid. The gland is normally walnut-sized and weighs about an ounce. However, sometimes the prostate gland enlarges and the condition is known as Benign Prostatic Hyperplasia or BPH. This condition leads to various symptoms that include:

  1. Difficulty in emptying bladder
  2. Urge to urinate frequently  
  3. Dribbling after urination
  4. Sometimes blood in urine

BPH is a normal condition affecting about 50% of men in their 50s and up to 90% of men in their 80s. Family History of BPH is one of the major risk factor in most cases of BPH.In some patients, the symptoms of BPH are mild, however in some severe cases they can cause a major impact on patient’s life. In such condition surgery is generally recommended. The two major surgical techniques used for BPH are:

  • Bipolar transurethral resection of prostate (TURP)
  • Holmium Laser enucleation and vapourisation of prostate

Bipolar transurethral resection of the prostate (TURP) – TURP is a surgery used to treat urinary problems due to an enlarged prostate. In this surgical procedure:

A combined visual and surgical instrument (resectoscope) is inserted into the urethra
Using the resectoscope, the urologist removes the  section of the prostate which is blocking the patient’s urine flow. Urologists generally recommend this procedure when the symptoms of BPH do not respond to medications.

Holmium Laser enucleation of the prostate (HoLEP) - HoLEP which is also known as holmium laser prostate surgery is a minimally invasive treatment for an enlarged prostate. In this surgical procedure: Holmium laser is used  to remove the part of prostate which is blocking the urine flow. A separate instrument is inserted to cut the prostate tissue into easily removable fragments

HoLEP procedure is similar to open surgery but involves no incisions and hence recommended for men with severely enlarged prostate.  HoLEP also offers added advantages such as reduced blood loss, faster recovery and shorter hospital stay as compared to TURP.

Vapourization of prostate – In this technique, a laser is employed to vapourize or melt away the extra prostate tissues so as to enlarge the urinary channel.

HoLEP is a modern alternative to the standard TURP surgical procedure, however whatever may be the type of surgery, certain precautions must be taken by the patient before and after the surgery for better and faster recovery.

Precautions to be followed before the surgery

  1. Inform the doctor about any medications or supplements taken  
  2. Patient  will be asked not to eat or drink anything after midnight before the surgery. On the day of surgery, any medication should be taken only after consulting the doctor.
  3. Avoid any strenuous activity before the procedure.

Precautions to be followed after the surgery

  1. Strenuous activities should be avoided after the surgery as  vigorous vibrations and movements can cause bleeding.
  2. Sexual activity should be also avoided for two weeks after surgery.
  3. Special attention should be given to diet. Coffee, tea, carbonated beverages, alcoholic beverages, spicy foods and smoking should be strictly avoided.
  4. Water and fiber intake should be increased for better bowel movement. Do not strain while having a bowel movement. In the case of constipations, laxatives should be used.
  5. Avoid driving or operating dangerous equipment at least for 48 hours after the procedure.

However, in the case of any other signs such as bleeding, inability to urinate, severe pain and fever, one must consult a urologist immediately. 

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Dr. Ajay Shetty.

Senior Consultant - Urology & Andrology

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