When is prostate resection (TURP or HoLEP) surgery necessary?
TURP (transurethral resection of the prostate), is the partial or complete removal or incision of the prostate through the urethra, whereas HoLEP (holmium laser enucleation of the prostate) may be necessary in cases of urinary incontinence, if conservative medical treatment has failed.
The prostate gland is the size of a chestnut and surrounds the posterior urethra between the bladder neck and the urethral sphincter. Around the age of 35, the prostate begins to grow, and by the age of 50 this growth may be so pronounced that it can compress the posterior urethra, thus obstructing the flow of urine. Symptoms of urinary incontinence may include:
- a weak and sometimes intermittent urine stream
- dribbling
- frequent urination
- urgent need to urinate
- slow onset of urination
- straining to maintain a urine stream while urinating
- difficulty urinating
- sudden complete inability to urinate, i.e., urinary retention
- frequent urination at night (nocturia)
- inability to completely empty the bladder (residual urine)
These complaints may be caused by prostate enlargement (prostatic hyperplasia), narrowing or stiffness of the bladder neck (sphincter sclerosis), and other neurogenic diseases of the bladder (e.g. hypo-/hypercontractile bladder, overactive bladder). If medication does not bring satisfactory results, resection of the prostate via the urethra using high-frequency current (diathermy) is recommended and has been the best proven treatment for decades.
An alternative solution is to ’shrink’ the prostate using heat treatment (e.g., laser, radio frequency energy). These alternative treatments are less effective than transurethral resection of the prostate.
As a result of the surgery, complaints related to frequent urination are reduced in most cases: difficult urination improves, the urinary stream becomes stronger and the amount of urine remaining in the bladder after urination decreases.
What preliminary tests are required?
In addition to the urological examination, a laboratory test and an anesthesiology consultation are required prior to the procedure.
How is TURP surgery performed?
TURP surgery is performed under general or spinal anesthesia. During the surgery, a special instrument for cystoscopy (resectoscope) is passed through the urethra into the bladder. This instrument has an electrified tip that uses high-frequency current to make incisions and stanch bleeding. The prostate tissue that bulges into the posterior urethra and obstructs the flow of urine is removed layer by layer. During the surgery, only the enlarged part of the prostate is removed, leaving the so-called surgical casing intact. This is an important aspect, because over the years - although rare - there is a possibility that the prostate will enlarge again. In addition, regular prostate cancer screening is recommended after the surgery, as for any other patient. This helps in the early detection and treatment of possible malignant changes in the prostate. The excised prostate tissue is subjected to histological examination. In contrast to prostate removal, the prostate incision is made at the bladder neck or the section of the urethra that passes through the prostate, so no material suitable for histological examination is removed in this case. At the end of the operation, a permanent bladder catheter is inserted for 2-5 days after the wound surface in the urethra has stopped bleeding.
How is laser prostate resection (HoLEP) performed?
The holmium laser is a high-energy, focused beam of light that generates heat when it comes into contact with tissue. This localized heat vaporizes the tissue, allowing precise removal (vaporization) or ablation of prostate tissue.
Holmium laser enucleation of the prostate (HoLEP) is a surgical procedure performed under general anesthesia or using a spinal anesthetic. The surgery is performed through the urethra using an endoscopic instrument. The holmium laser at the tip of the instrument allows the enlarged prostate tissue to be precisely separated from the prostate capsule. The removed tissue is placed in the bladder, where it is chopped up and aspirated using a dedicated instrument (morcellator). The removed tissue is subjected to histological examination to rule out any malignant changes. At the end of the surgery, a bladder catheter is inserted and left in place for 1–3 days to promote wound healing and drain urine.
This procedure is especially recommended for larger prostate sizes, as it minimizes risks, provides a shorter recovery time, and provides a long-term effective solution for treating prostate enlargement.
Advantages of the laser procedure over the traditional TURP procedure
- HoLEP allows for the effective reduction of larger prostate sizes, which can be more time-consuming and riskier with the traditional TURP procedure.
- The laser immediately seals the blood vessels, reducing the risk of intraoperative and postoperative bleeding, significantly reducing blood loss.
- The chance of tissue regrowth is lower than with traditional TURP.
- The end result of the surgery in terms of the ability to urinate is equivalent to TURP surgery.
What should the patient do after prostate resection surgery?
Depending on the size of the prostate, 1-3 nights of hospital observation are usually required, post-surgery. The catheter is removed 1-5 days after the procedure and it is recommended to take antibiotics and anti-inflammatory drugs, as prescribed by the doctor.
Adequate fluid intake is of utmost importance after the surgery, and it is recommended to drink 2-3 liters of fluid per day. Avoiding heavy physical exertion for at least 4 weeks is also recommended.
If there are complaints related to urination after the procedure, these will be checked, and urine flow will be measured during the postoperative check-up.
What are the risks of TURP and HoLEP surgery?
TURP surgery may cause changes in erectile function, but the procedure does not affect erectile function. However, fertility is lost in approximately 70% of cases, because the incision in the bladder neck causes the semen to enter the bladder rather than the urethra during ejaculation. The semen is released from the bladder during the next urination. This condition does not pose any health risks.
After TURP and HoLEP procedures, there may be postoperative bleeding, irritative complaints, and temporary urinary retention problems. Less commonly, inflammatory complications, hospital-acquired infections, or deep vein thrombosis may occur, the risk of which is minimal if proper protocols are followed.
Prostate resection (TURP and HoLEP) surgery fees
You can find our current fees under our prices menu.
WHY CHOOSE DR. ROSE PRIVATE HOSPITAL?
- Highly skilled specialists, modern diagnostic and therapeutic equipment.
- Empathetic, people-centered approach. Our specialists always keep the comfort and safety of our patients in mind.
- Premium inpatient department. Available to our patients are 3 operating rooms and 24 patient rooms with 33 beds to meet all needs. The highest professional standards meet with an exclusive environment where you can heal in safety and with complete peace of mind.
- Fast and predictable appointments. We provide an appointment for the necessary intervention within 1-2 weeks of the first specialist consultation.
For all your urological complaints, contact the doctors at Dr. Rose Private Hospital with confidence.