Benign Enlarged Prostate

The prostate gland

The prostate is a small organ located below the bladder. Its main job is to produce fluid that protects and nourishes sperm. As men age, the prostate grows larger, usually driven by the male hormone testosterone, age and possibly genetics. The prostate gland is typically the size of a walnut at age 21, and size may double between the ages of 21 and 50. Then, from 50 to 80 years old, it almost doubles in size again. The reasons behind this ongoing growth still need to be fully understood.

Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH) is the most common prostate disease. BPH is a non-cancerous enlargement or growth of the prostate gland. As the prostate surrounds the upper part of the tube that carries urine (urethra), its enlargement can narrow the urethra and put pressure on the bladder opening. This narrowing can cause problems with urination in various ways, such as a weak flow, straining to urinate, and a sensation of incomplete or dribbling after urination. There may be other effects on the bladder, such as urgent or frequent urination during the day and night.

It’s important to note that BPH is usually not life-threatening, but its symptoms can significantly impact your quality of life. BPH is more common in older men, typically starting after age 40. Nearly all men will experience BPH at some point in their lives. However, some men may not have any symptoms even though their prostate has grown. BPH becomes more problematic over time, with symptoms worsening if left untreated.

– Urolift

Urolift is a minimally invasive procedure that pins the prostate tissue back to open a channel allowing the unobstructed passage of urine. It is typically done as a day case under general anaesthetic without the need for a catheter. It is a good option for those that do not wish to take tablets and avoid more invasive procedures. Importantly, the procedure preserves the ejaculation function. Other prostate surgeries can easily be performed after Urolift if required.

– HoLEP

Holmium laser enucleation of prostate (HoLEP) uses a specialised laser through a telescope to remove the entire obstructing prostate tissue and leave an open cavity. This is quickly becoming the standard of care for benign prostate surgery since it remains durable with less bleeding than a TURP. It can be performed on any size of prostate and this minimally invasive technology eliminates the need for an open or robotic removal (simple prostatectomy). The procedure is similarly performed under general anaesthetic and requires a catheter for one to two days post procedure.

– Greenlight vaporisation

Using a high-powered laser through a telescope, the prostate cavity is created by vaporising the tissue. Like the other procedures, this creates an open channel under general anaesthetic with a catheter placed for one to two days. It is unclear whether the long-term results are as durable as HoLEP or TURP, but it remains a good option for those at high risk of bleeding due to medications or blood disorders.

– TURP

During a TURP, a telescope is passed through the urethra and a hot wire is used to shave prostate tissue away and create an open cavity allowing the free passage of urine. This procedure is one of the most durable, is performed under general or spinal anaesthetic and requires one to two days with a catheter.