If symptoms are severe, or if medicines do not help, partial removal of the prostate is an option. Approximately 25% of men with an enlarged prostate will require an operation at some stage.
The operation involves only the central part of the prostate to be removed (thus creating a wide channel for urine to flow through), leaving the outer part behind. This is different to surgery for prostate cancer where the entire prostate may be removed.
There are many options for removing prostate tissue. Your Consultant will discuss the most suitable operation for you in more detail.
Transurethral resection of the prostate (TURP)
TURP is the most common operation carried out for an enlarged prostate. Under anaesthetic, either spinal or general, a rigid cystoscope is inserted through the urethra into the bladder. A cystoscope is a narrow tube-like telescope through which small instruments pass to allow the operation to be carried out. A semicircular loop of wire has an electrical current passed through it. It is this loop that sticks out from the end of the cystoscope and cuts out small chips of prostate that are then washed out at the end of the operation. This operation nearly always gives good relief of symptoms. 80-90% of men after this operation will have retrograde ejaculation, which is when semen goes backwards into the bladder at climax producing a ‘dry’ orgasm. Impotence and incontinence are rare complications after a TURP.
Transurethral incision of the prostate (TUIP)
TUIP may be offered if you only have a slightly enlarged prostate. For this operation, the surgeon makes small cuts in the prostate where the prostate meets the bladder. This then relaxes the opening to the bladder, resulting in there being an improved flow of urine out of the bladder. There is less risk of retrograde ejaculation with this operation.
HoLEP – minimally invasive procedure for very large prostates
HoLEP is a laser surgery for men who have a very large prostate. The procedure is minimally invasive and uses a high-powered laser to detach the ‘flesh’ of the prostate from the capsule. This is then transferred to the bladder and suctioned out. The major advantage of this procedure is that you can treat prostates too large to be operated on safely using other methods. A HoLEP procedure is safe and effective, even for the largest of prostates, and has a faster recovery time than other prostate procedures.
This is simply the application of newer technologies to achieve the same goal as either TURP or open prostatectomy. It has the advantage of fewer side-effects, a shorter period of having a catheter in, and a shorter stay in hospital (often just one night). There are two types of lasers: green light which vaporises the prostate tissue to create a cavity, and holmium or thulium lasers that can very effectively core out large pieces (lobes) of prostate which, in turn, are chopped into small pieces in order to be removed from the bladder. In the hands of experienced laser surgeons, very large prostates, which in the past could only be dealt with by open surgery, can be removed by this technique.