Surgical Care For Prostate Hypertrophy

Prostate hypertrophy is a benign (non-cancerous) condition in which there is an overgrowth of the prostate tissue (enlarged prostate) in men. It is also called as benign prostatic hyperplasia (BPH). Excess prostate tissue may push against the urethra and the bladder, blocking the flow of urine. The cause of prostate enlargement is unknown; however, it is believed to be linked with hormonal changes, this is common over the age of 50.

Although, the enlargement is neither cancerous nor does it increase your risk for prostate cancer, this is removed via minimally invasive or extensively invasive procedures, as obstruction of urine is not a desirable outcome and effects quality of life.

Symptoms & Diagnosis

Common symptoms of prostate hypertrophy or prostate enlargement are:

• Difficulty in starting to urinate
• Frequent need to urinate
• Urinary bladder does not fully empty itself (urine retention)

Diagnosis: After reviewing your symptoms and a detailed physical exam, your healthcare provider may prescribe following diagnostic tests:

• Urine and blood tests to check the function of kidneys
• If necessary, cystoscopy (a special telescope) for a closer look inside the bladder
• Ultrasound scan to check prostate size and status of the kidneys and also volume of urine retention
• Urine flow test to know the degree of urine obstruction

Treatment

Medications are prescribed to inhibit the hormones that cause BPH and to relax the bladder. Surgery is recommended in cases, that don’t respond to medications.

Surgical treatments include both minimally invasive and invasive types.

Minimally Invasive Procedures

Minimally invasive procedures do not require cutting or removing the prostate, instead they are done with small instruments to remove excess tissue in the prostate. Your healthcare provider will evaluate the size of your prostate and severity of condition in your case before deciding a treatment type.

Some of the benefits of these type of treatments are – they relieve symptoms better than medicines, faster recovery, less painful and fewer risks.

Discussed below are the minimally non-invasive procedures for BPH:

1. Transurethral resection of the prostate (TURP): This is the most common surgery to treat prostate enlargement. This involves removing portions of the prostate that are obstructing the urine flow. This is done with an insertion of scope through the urinary bladder and does not require cutting of the tissue, and no scars are left. Retrograde ejaculation (ejaculation of semen into the bladder instead of through the urethra) is a common complication of this procedure.
2. Transurethral incision of the prostate (TUIP): This procedure is opted in those with smaller prostates. This involves making smaller cuts in the prostate to reduce the gland’s pressure on the urinary tube, that makes urination easier. With TUIP, risk of getting retrograde ejaculation is much less compared to TURP.
3. HOLEP: Holmium laser enucleation of prostate is another mimimally invasive modality of treatment for benign prostatic hylerplasia.

Simple prostatectomy: Simple prostatectomy is the surgical removal of the prostate from outside. This surgery removes much of the prostate, but it may or may not remove all of the prostate. It may be done as an open surgery, a laparoscopic surgery, or as a laparoscopic surgery with robotic assistance.

Simple prostatectomy is not done very often nowadays in the era of minimal invasion. It may be recommended if:

• You have a very large prostate.
• You have bladder diverticula (pouches in the wall of the bladder) or bladder stones.
• Transurethral resection of the prostate (TURP) is not possible for another reason

Complications of Surgical treatments

The surgeries used in removing excess prostate tissue are generally safe. However, some might face complications like:

• Urinary tract infection
• Retrograde Ejaculation
• Blood in urine
• Inability to control urine
• Stricture of thr urethra
• Erectile dysfunction

Surgery for prostate enlargement is very commonly done nowadays mostly by minimally invasive methods. Identifying your symptoms early and reaching out your healthcare provider can help to help the resolve the problem at the earliest.

Dr Muruganandham K

MBBS, MS, DNB, MCh, FMAS

HOD and Senior Consultant

Department of Urology & Renal Transplantation