Do Laser Treatments Have Any Advantages Over Turp
As well as the standard approaches such as TURP, there are a number of other surgical techniques. They mainly differ in terms of the instruments and sources of energy used to remove or destroy the prostate tissue. Most of the other techniques are carried out using laser beams. Like in TURP, the instruments are inserted into the urethra and guided to the prostate.
The laser treatments include:
- Wasson JH, Reda DJ, Bruskewitz RC, Elinson J, Keller AM, Henderson WG. A comparison of transurethral surgery with watchful waiting for moderate symptoms of benign prostatic hyperplasia. The Veterans Affairs Cooperative Study Group on Transurethral Resection of the Prostate. N Engl J Med 1995 332: 75-79.
-
IQWiG health information is written with the aim of helpingpeople understand the advantages and disadvantages of the main treatment options and healthcare services.
Because IQWiG is a German institute, some of the information provided here is specific to theGerman health care system. The suitability of any of the described options in an individualcase can be determined by talking to a doctor. We do not offer individual consultations.
Our information is based on the results of good-quality studies. It is written by ateam ofhealth care professionals, scientists and editors, and reviewed by external experts. You canfind a detailed description of how our health information is produced and updated inour methods.
What Are The Procedures For Surgery Of Enlarged Prostate
The most commonly performed surgery for enlarged prostate is transurethral resection of the prostate .
This surgical procedure involves the insertion of a scope or an instrument through the penis to scrap the innermost portion of the prostate piece by piece. This is believed to be the most effective surgical procedure since it can relief your symptoms immediately as well.
Another procedure of enlarged prostate surgery is transurethral incision of the prostate .
This operation resembles TURP, but it is indicated when the size of prostate enlargement is relatively small. It is a non-invasive surgical procedure which means that you will not need to be hospitalized after it.
Similar to TURP, a scope is introduced through the penis till reaching the prostate afterward a small cut is done to widen the hole of urethra as well as bladder opening, rather than completely getting rid of prostate in TURP.
In Simple prostatectomy a small incision is performed in the abdominal area to remove the inner most part of the enlarged prostate, while the superficial part is left.
Simple prostatectomy is definitely performed under general anesthesia. This enlarged prostate surgery involves prolonged procedures and you will need to be hospitalized from five to ten days after having it.
Nowadays there are myriad less invasive techniques to treat prostate enlargement which can be done in your doctors clinic under local anesthesia or other sedations, you will not need to be hospitalized.
What Is The Most Common Approach
A technique called transurethral resection of the prostate is considered to be the standard surgical approach. This procedure involves inserting a thin tube called a resectoscope into the urethra and guiding it through to the prostate. The resectoscope is equipped with a tiny camera and an electrical loop that is used to mechanically remove prostate tissue. The loop produces heat at the same time, which quickly seals off the blood vessels. The resectoscope also has valves that regulate the release of fluid to flush the removed tissue out. TURP takes about 90 minutes and is done under local or general anesthetic. Men who have had this procedure usually need to have a urinary for a few days after, and generally stay in the hospital for two to seven days. They then have to rest and take it easy for a few weeks.
Some variations of TURP are also considered to be standard treatments and have similar outcomes and consequences to conventional TURP. These include transurethral electrovaporization , transurethral vaporesection and plasmakinetic enucleation of the prostate .
Recommended Reading: How Big Is A Normal Prostate
Risks And Side Effects Of Turp
TURP can cause long-term problems with ejaculation, orgasm, erection, and infertility.
Semen may flow backward into the bladder, a condition termed retrograde ejaculation, or dry orgasm. Retrograde ejaculation may affect up to 6575% of males who have undergone TURP, according to the National Health Service .
Retrograde ejaculation can also make orgasm feel different or less pleasurable. It also reduces fertility.
TURP has variable effects on erectile dysfunction. In a small study involving 264 men who underwent TURP, 5.8% of the 109 men who had good erectile function before TURP reported worsening erectile function afterward. However, of the 136 men who reported mild to moderate erectile dysfunction before surgery, 16.2% reported an improvement afterward. Other research indicates permanent erection problems are rare.
Other potential problems with TURP include:
- damage to the urethra or bladder
- transurethral resection syndrome, a concerning but uncommon complication
- scar tissue on the urethra, which makes it harder to urinate and requires additional surgery
- , which may subside in the weeks following surgery
Cystoscopy Procedure For Your Prostate
The urologist may insert a camera catheter, also known as a cystoscopy procedure, to do a prostate examination if they suspect a serious problem.
Also known as a bladder scope, the camera allows the doctor to see the inside of the prostate and bladder. An enlarged prostate can cause problems in the bladder, and a cystoscopy procedure can enable your doctor to see whats going on inside your prostate and bladder.
This procedure enters not through the rear as in a normal DRE but the front down the penis inside the urethra through the prostate gland and into the bladder.
The cystoscope has lenses that allow your doctor to see inside the prostate, bladder and urinary tract. The images usually appear on a computer screen as she guides the scope.
The cystoscope has lenses that allow your doctor to see inside the prostate, bladder and urinary tract. The images usually appear on a computer screen as she guides the scope.
Cystoscopes come in different sizes: from the thickness of a pencil, to approximately 9mm and have a light at the tip. Many cystoscopes have extra tubes to guide other instruments for surgical procedures to treat urinary problems.
Yup, this one can hurt especially if done fast, as my urologist did! The catheter and camera size are not small. They did use a local anesthetic gel, xylocaine, but it did not make much difference to me.
This will ease with each urination. Some blood spotting is also possible but this too will pass.
Read Also: Prostate Cancer In Bones And Lungs
The Different Types Of Prostate Surgery
Prostatectomy
The term prostatectomy is used to describe a number of different surgical procedures to remove either part or all of the prostate gland. This may be required to treat prostate cancer or BPH.
When only a part of the prostate is removed, this is called a simple prostatectomy. This process involves enucleating it from its capsule to trim away excess tissue, but where the sphincter muscle and nerves remain intact. It is usually used to treat BPH, which is a benign condition, meaning there is no risk of malignant cells having moved on to surrounding tissue.
When the entire prostate gland, capsule , the surrounding lymph nodes and neighbouring tissue is removed, this is known as a radical prostatectomy. This is usually a treatment for men with localised prostate cancer and there a number of techniques used:
Open Surgery This is where the prostate is removed via a large single incision in the lower abdomen, or the perineum .
Laparoscopic Radical Prostatectomy This is where the prostate is removed via several small incisions in the lower abdomen using small surgical instruments. This process is much less invasive than open surgery.
Robotic-assisted radical prostatectomy Much like laparoscopic radical prostatectomy, the prostate is removed via small incisions in the lower abdomen. Robotic-assisted instruments are inserted through the incisions and controlled by a surgeon.
Holmium Laser Enucleation of the Prostate
Transurethral Resection of the Prostate
Bph Surgery Phoenix Scottsdale
Benign prostatic hypertrophy , also known as enlarged prostate, is an extremely common condition that affects roughly half of men over 60, and an estimated 90% of men in their 70’s and 80’s.
Although medication can be effective in treating BPH, surgery is often necessary to effectively address this condition. Transurethral resection of the prostate , also known as a “roto-rooter”, is the standard surgical treatment for enlarged prostate and involves scraping excess tissue from the inside of an enlarged prostate gland with an electrical knife. Greenlight XPS is a newer surgery involving a laser that achieves the same outcomes as a TURP but with less side effects and quicker recovery. This remains an excellent option for men suffering from moderate to severe BPH symptoms, and can even be done in the comfort of the office, both under sedation and even under local anesthetic .
The newest weapon in the treatment of BPH is now the UroLift® procedure. Urologist Dr. Mark Hong proudly offers this new and innovative Urolift procedure at his Phoenix practice. Benefits of this minimally invasive procedure include reduced discomfort, faster recovery and less risk especially to sexual function. To learn whether you are a good candidate for UroLift, schedule a consultation at our practice today.
Read Also: Prostate Cancer How Long To Live
Why Is Turp Performed
TURP is the gold standard surgical therapy for an enlarged prostate.
The medical term for an enlarged prostate is benign prostatic hyperplasia . It is a noncancerous condition that can occur with age.
When the prostate gland grows to excess, it presses against the urethra and bladder, causing:
- a feeling of a full bladder even though you already urinated
TURP reduces the size of the prostate so that urine flows freely. TURP is also used to drain prostate abscesses.
TURP is not a treatment for . However, a doctor may study a sample of tissue from TURP to determine whether it contains cells.
Prostate Laser Surgery Recovery Time:
The recovery time for laser BPH surgery such as Greenlight Laser Prostatectomy is much shorter than the recovery time for traditional BPH procedures.
- Because it is an outpatient procedure you will most likely spend no nights in the hospital
- Normal activities can begin a few days after surgery
- Strenuous activities can begin 2 weeks after surgery
Recommended Reading: What Is Sbrt Treatment For Prostate Cancer
During Surgery For Prostate Cancer
The most common type of surgery to treat prostate cancer is a radical prostatectomy. This surgery involves removing the entire prostate gland along with nearby tissues .
Since the prostate gland normally connects the bladder to the urethrathe tube inside the penisthe surgeon must also reattach the bladder to the urethra once the prostate gland is removed.
A radical prostatectomy can be performed in three different ways:
- Open radical prostatectomy: The surgeon accesses the prostate gland by making a larger incision over the lower abdomen. Less commonly, the prostate is accessed through an incision made between the anus and scrotum .
- Laparoscopic radical prostatectomy: This minimally invasive approach involves accessing the prostate gland by inserting long, thin instruments through several keyhole-size incisions made in the lower abdomen.
- Robotic-assisted radical prostatectomy: With this approach, the surgeon sits at a computer console and manipulates mini robotic arms/instruments to remove the entire prostate gland. Robotic-assisted is the most common way a prostate is removed for cancer today.
Following Up After Surgery
Because surgery for benign prostatic hyperplasia leaves behind most of the prostate gland, it is still possible for prostate problemsincluding prostate cancer or benign prostatic hyperplasiato develop or return.
After your surgery, it is important to continue having a rectal exam once a year and to have any symptoms checked by your doctor.
You May Like: Can You Reduce An Enlarged Prostate
Why The Procedure Is Performed
An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your doctor may tell you changes you can make in how you eat or drink. You may also try some medicines.
Prostate removal may be recommended if you:
- Cannot completely empty your bladder
- Have repeat urinary tract infections
- Have bleeding from your prostate
- Have bladder stones with your enlarged prostate
- Urinate very slowly
- Took medicines, and they did not help your symptoms or you no longer want to take them
Find Your Nearest Spire Hospital
Almost all of our hospitals offer private prostate surgery and have teams of urologists who specialise in this procedure.
There are several methods available for prostate surgery.
TURP
The standard method is transurethral resection of the prostate . During a TURP procedure, which is usually performed under general anaesthetic, your surgeon will:
- Insert a resectoscope through your penis into your urethra and bladder
- Pass a small, electrically-heated wire loop through the resectoscope
- Trim small central pieces of prostate tissue using the wire loop to create a channel where urine can easily pass through, and extract the pieces by suction
- Insert a thin tube called a catheter through your penis and into your urethra
- Use the catheter to flush out any blood clots, urine or remaining prostate tissue from your bladder using a saltwater solution
- The catheter will remain in place for around one to three days after the operation
TURP may also be performed to treat or prevent any further complications as a result of blocked urine flow, including recurring UTIs, kidney and bladder damage, bladder stones, blood in the urine and difficulties in urination.
Laser prostate surgery
With laser prostate surgery, your surgeon will follow the same steps as TURP, but instead of using a resectoscope with an electrically-heated wire to cut away your prostate, theyll use a scope which has a special laser . The laser generates precise and intense heat to cut away sections of your enlarged prostate.
You May Like: Symptoms Of Enlarged Prostate In Dogs
How Effective Is Turp And What Consequences Can It Have
Studies have shown that TURP can permanently reduce prostate-related problems. Nine months after having TURP, about 75 out of 100 men only have mild symptoms. For example, at night they only need to get up to go to the bathroom once, or not at all. The other men usually still benefit from TURP, but the effect is smaller. Side effects are common, though.
The most common side effect of TURP is dry orgasm” or “dry climax” . This is where no semen, or much less than usual, leaves the penis during ejaculation. Instead, the semen flows into the bladder. This can happen if the muscles that normally close the entrance of the bladder during ejaculation are damaged during surgery. About 65 out of 100 men have this side effect after TURP. Although dry orgasms arent harmful and usually dont affect mens sexual pleasure during orgasm, they do reduce .
Some men are afraid that they will have erection problems after surgery. Although there is no guarantee that this wont happen, research has shown that permanent erection problems are rare. Some men even feel more comfortable with their sexuality after surgery because they no longer have bothersome symptoms such as having to go to the bathroom a lot.
What Is A Cystoscopy
A cystoscopy is a test to check the health of your urethra and bladder. You might also hear it called a cystourethroscopy or, more simply, a bladder scope.
Itâs an outpatient test, which means you can get it at your doctorâs office, a hospital, or clinic and go home the same day. The doctor inserts a tube into your urethra. If youâre a man, the opening is at the end of your penis. If youâre a woman, itâs just above your vagina. The test lets your doctor check the complete length of your urethra and the bladder for polyps, narrow areas called strictures, abnormal growths, and other problems.
Recommended Reading: Best Over The Counter Prostate Medicine
What To Expect On The Day Of Your Turp
The day of your surgery, you can generally expect to:
- Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
- Go to the bathroom to empty your bladder.
- Change into a hospital gown.
- Talk with the or nurse anesthetist about your medical history and the type of anesthesia you will receive.
- Talk with your surgeon about the procedure and what to expect when you wake up.
- A surgical team member will start an IV and your anesthesia.
- The anesthesiologist or may place a tube in your windpipe to protect and control breathing during general anesthesia.
- Your inserts the resectoscope and advances it to the prostate. Electric current heats the wire at the end of the scope. This cuts away the prostate tissue in tiny pieces while also minimizing bleeding.
- The surgical team will monitor your lung and heart function throughout the procedure and during recovery.
- You will wake up after surgery with a catheter in your penis. The catheter drains the bladder continuously. Your doctor will remove the catheter within a week after surgery.
What Does It Mean
A Gleason score of 6 is low grade, 7 is intermediate grade, and a score of 8 to 10 is high grade cancer.
Get More Information
Its also important to know whether any cells rated at Gleason grade 5 are present, even in just a small amount, and most pathologists will report this. Having any Gleason grade 5 in your biopsy or prostate puts you at a higher risk of recurrence.
But because many prostate cancer cases are extremely slow-growing, the Gleason system didnt necessarily do a good job of communicating the risks for these cases. Patients with scores of 6 and 7 didnt have a clear picture of the nature of their particular cancer.
Recommended Reading: Etapas Del Cancer De Prostata