Enlarged Prostate – Benign Prostatic Hyperplasia (BPH)

Symptoms of an enlarged prostate

Often an enlarged prostate does not cause any problems but if symptoms occur, these include:

• Weak urine flow
• Hesitancy in emptying the bladder
• Feeling your bladder is not empty after you have been to the toilet
• Frequency in passing urine

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. If left untreated, an enlarged prostate resulting in urinary symptoms can lead to infections and more rarely, kidney damage.

Diagnosing an enlarged prostate

A doctor will examine your prostate and take blood and urine tests to check the function of your kidneys and rule out other potential problems. A specialist may use cystoscopy – a special instrument to examine the bladder. You could also have a scan to examine the prostate and bladder, and a urine flow test to assess the blockage.

Treating an enlarged prostate

Surgery is not always necessary and some people may just need regular monitoring of the condition. Medication can be used to relax the muscle tissue around the bladder, and in this instance, most people will notice an improvement within days.

Transurethral resection of the prostate (TURP)

This procedure involves removing sections of the prostate bit by bit from the center outwards. This is done using an electrosurgical loop. This leaves more space for the urethra (the tube through which urine leaves the body), so freeing up the flow of urine.

Whilst this procedure is highly effective for smaller and mid sized prostates, it isn’t recommended for very large ones. This is because as the tissue is shaved away, it bleeds, and will carry on bleeding until the capsule (the outer part of the prostate) is reached. If there is a lot of tissue to shave away, the blood loss can be significant and could result in needing a blood transfusion.

TURP is performed under general or spinal anaesthetic, usually lasts around 45 minutes and involves no incisions on the outside. After the operation, a catheter is inserted for 2 days, through which irrigation fluid flows into the bladder and rinses any blood out.

Patients can leave hospital 48 hours after their TURP procedure and should avoid heavy physical exercise for 2 weeks. Urinary flow is usually markedly improved immediately but frequency may take 6-12 weeks to completely settle. All patients experience retrograde ejaculation after TURP i.e. sperm going back into the bladder at the time of climax, rather than coming out of the penis. There is also a 5% risk of impotence after TURP, usually in men aged over 70 years.

Transurethral resection in saline (TURis)

TURis is an electrosurgery system used at our Urology Clinic during TURP procedures. Although the procedure remains the same as the traditional method for TURP, TURis involves using saline solution instead of glycerine to deliver the electricity.

The main advantage of this is the reduced risk of serious complications. If too much glycerine is absorbed into the bloodstream, it can cause TURP syndrome. In rare cases, this can result in seizures, heart pain and even coma.

TURis also allows the electrosurgical loop to reach higher temperatures. This increased heat, and the type of energy used, is better at sealing blood vessels, and so patients bleed far less.

At our Urology Clinic, we provide TURis as a day case procedure, meaning patients can go home the same day.

HoLEP

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 inner ‘flesh’ of the prostate from the outer 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.

HoLEP is recommended for larger prostates as the laser technique allows the obstructing prostate tissue to be separated from the capsule more efficiently in one chunk instead of multiple pieces. This significantly reduces blood loss and removes the maximum amount of tissue possible, preventing regrowth of the prostate. The laser light is also exceptionally good at stopping bleeding, so much so that the procedure can also be done on patients taking blood-thinning medications.

Contact us

If you think you have an enlarged prostate and would like to find out more about treatment options, call the Urology Clinic on 020 7432 8297 or email [email protected].