Benign prostatic hyperplasia (BPH) is a common condition where the prostate gland enlarges, causing urinary problems in men, particularly those over 50. When medications and lifestyle modifications no longer provide adequate symptom relief, surgical treatment may become necessary. This article outlines the primary surgical options for BPH, ranging from traditional open surgery to minimally invasive techniques, comparing their methods, effectiveness, and recovery profiles to help patients make informed decisions about their care.
Minimally Invasive Surgical Techniques
Modern surgical approaches offer alternatives to traditional open surgery with shorter recovery times and fewer complications.
Transurethral Resection of the Prostate (TURP): During TURP, a resectoscope is inserted through the urethra to remove excess prostate tissue using an electrical loop. The procedure typically requires 1-3 days of hospitalisation, with a catheter for 24-48 hours post-surgery. Most men experience significant symptom improvement, though temporary urinary incontinence and retrograde ejaculation are common side effects.
Transurethral Incision of the Prostate (TUIP): Rather than removing tissue, TUIP involves making one or two small cuts in the prostate and prostate capsule to reduce pressure on the urethra. This procedure is typically reserved for men with smaller prostates and offers shorter recovery times and lower risks of retrograde ejaculation compared to TURP.
Holmium Laser Enucleation (HoLEP): This procedure uses a high-powered laser to precisely remove obstructive prostate tissue and seal blood vessels simultaneously. The excised tissue is then pushed into the bladder and removed. HoLEP is particularly effective for larger prostates and can be an alternative to open surgery. Benefits include minimal bleeding, shorter hospital stays, and the best durability amongst all enlarged prostate surgery.
GreenLight Laser (Photoselective Vaporisation): This technique uses a specific wavelength laser that is selectively absorbed by the haemoglobin in blood vessels. The laser energy vaporises the prostate tissue, creating an immediate opening in the prostatic urethra. GreenLight procedures typically involve overnight catheterisation and can often be performed as day cases. This approach is particularly valuable for patients on blood thinners due to its haemostatic properties, but has higher reoperation rates compared to TURP or HoLEP.
Prostatic Urethral Lift (UroLift): This minimally invasive surgical technique involves placing small implants to pull apart and hold the enlarged prostate tissue, creating an opening in the urethra. The procedure can be performed under local anaesthesia, typically takes less than an hour, and often does not require post-operative catheterisation. While it preserves sexual function and offers rapid recovery, it may be less effective for very large prostates.
Rezūm Water Vapour Therapy: This minimally invasive surgical intervention uses radio-frequency energy to create water vapour (steam) that is injected into the prostate tissue. The steam destroys the targeted cells, which are then naturally absorbed by the body, reducing the size of the prostate and relieving obstruction. Rezūm typically takes 10-15 minutes to perform in an outpatient setting. Most men require catheterisation for only a few days, with symptom improvement occurring gradually over several weeks as the body reabsorbs the treated tissue.
Traditional Surgical Approach
For severe cases or very large prostates, more extensive surgical intervention may be required.
Open/Robotic Simple Prostatectomy: This traditional surgical approach involves making an incision/keyhole incisions in the lower abdomen to remove the inner portion of the prostate. It is typically reserved for men with very large prostates or those with additional bladder complications requiring repair. While effective, open prostatectomy entails longer recovery time, greater blood loss, and longer hospitalisation compared to other techniques. HoLEP can be a better alternative to such approaches with faster recovery.
Comparing Recovery and Outcomes
Recovery Timeline: Recovery periods range from a few days for minimally invasive procedures like UroLift and Rezūm to several weeks for TURP and open prostatectomy. Most procedures require some period of catheterisation, from less than 24 hours for some minimally invasive options to 1-2 weeks for more extensive surgeries. Return to normal activities generally follows a similar pattern, with faster recovery for less invasive approaches.
Symptom Improvement: The degree and speed of symptom relief vary between procedures. TURP and HoLEP typically offer the most immediate improvement in urinary flow, while thermal therapies like Rezūm show more gradual improvement over 1-3 months as the body absorbs treated tissue.
Complications and Side Effects: Sexual function impacts differ markedly between procedures. Retrograde ejaculation (where semen enters the bladder rather than exiting through the urethra) occurs in 65-75% of men after TURP but is less common with UroLift and Rezūm. Erectile dysfunction risk is generally low across all modern procedures. Urinary incontinence is typically temporary but varies in frequency and duration between techniques.
Patient Selection Factors
The choice of BPH surgical procedure varies based on several factors. Prostate size often determines the approach—smaller glands (under 80 grams) suit UroLift and TUIP, while larger ones may require HoLEP or open surgery. Patients taking anticoagulants benefit from laser procedures such as HoLEP or Greenlight laser. UroLift and Rezum are options for younger men who are concerned about their ejaculatory function, but they may need surgical retreatment at a later stage.
Conclusion
Minimally invasive surgical approaches offer effective treatment for BPH with shorter recovery times. Surgical options range from TURP, which remains a reliable method, to newer techniques such as laser procedures, UroLift, and Rezūm. These newer methods typically allow for quicker recovery times and cause fewer side effects. When selecting a treatment, doctors consider prostate size and shape, overall health, and patient preferences about recovery duration and sexual function.
If you are experiencing BPH symptoms that interfere with your daily life, contact urologist specialist in singapore to discuss the best treatment options for your situation.
