Prostate Surgery

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Prostate Surgery

When it comes to prostate surgery for Benign Prostatic Enlargement (BPE), two common procedures are Transurethral Resection of the Prostate (TURP) and Holmium Laser Enucleation of the Prostate (HoLEP). Both procedures are effective in relieving symptoms caused by an enlarged prostate, but they differ in their techniques, advantages, and potential risks. Here’s an overview of each:

1. TURP (Transurethral Resection of the Prostate)

  • Description: TURP is a surgical procedure where a resectoscope is inserted through the urethra to remove parts of the prostate that are causing obstruction.
  • Indications: Generally recommended for moderate to severe urinary symptoms due to BPE.
  • Procedure:
    1. The patient receives spinal or general anesthesia.
    2. A resectoscope (a tube with a camera and a loop of wire) is inserted through the urethra.
    3. The wire loop is used to cut away excess prostate tissue.
    4. The removed tissue is flushed out with fluid.
  • Advantages:
    • Considered the gold standard for treating BPE.
    • Significant and quick improvement in urinary symptoms.
    • Long track record with well-understood outcomes.
  • Disadvantages:
    • Requires a hospital stay.
    • Risk of bleeding, infection, and retrograde ejaculation (semen enters the bladder instead of exiting through the urethra).
    • Potential for TUR syndrome (a rare but serious condition caused by the absorption of irrigation fluids).

2. HoLEP (Holmium Laser Enucleation of the Prostate)

  • Description: HoLEP uses a holmium laser to enucleate and remove the excess prostate tissue causing obstruction.
  • Indications: Suitable for patients with moderate to severe urinary symptoms and larger prostates.
  • Procedure:
    1. The patient is given spinal or general anesthesia.
    2. A laser fiber is inserted through a scope into the urethra.
    3. The laser is used to cut and remove the obstructive prostate tissue.
    4. Tissue is pushed into the bladder and then removed using a morcellator.
  • Advantages:
    • Effective for a wide range of prostate sizes, including very large prostates.
    • Minimal bleeding due to the precision of the laser.
    • Shorter catheterization time and hospital stay compared to TURP.
    • Lower risk of needing a repeat procedure.
  • Disadvantages:
    • Requires specialized training and equipment.
    • Potential for retrograde ejaculation.
    • Some patients may experience temporary urinary incontinence.

Choosing Between TURP and HoLEP

  • Prostate Size: HoLEP is particularly effective for larger prostates, while TURP is suitable for moderate enlargement.
  • Patient Health and Preferences: Consideration of the patient’s overall health, tolerance for anesthesia, and preference for hospital stay duration and recovery time.
  • Availability and Expertise: Availability of specialized equipment and the surgeon’s expertise with the procedure.

Summary

Both TURP and HoLEP are effective treatments for BPE, with TURP being the traditional gold standard and HoLEP offering advantages for larger prostates and reduced bleeding. TURP has a long history and well-documented outcomes, while HoLEP offers a modern, minimally invasive approach with a faster recovery time. Consulting with a urologist will help determine the most appropriate treatment based on individual circumstances, prostate size, and patient health.