Benign Prostatic Hyperplasia (BPH)
Part 4: Surgical options
This is the final of my 4-part series in BPH, a common condition as men get older; last week I discussed medication that control symptoms.
If, after lifestyles changes and / or medication treatment symptoms have not worked or indeed, the symptoms have deteriorated over time, the GP will most likely refer the patient to a consultant urologist to review the case and identify next steps in improving the situation.
There are a variety of minimally invasive or surgical procedures available, a short overview of some of these are outlined below: -
TURPS (Transurethral resection of the prostate)
This surgery had been the primary treatment for BPH since the late 50’s. The procedure involves inserting a scope through the urethra and removing all but the outer part of the prostate. It is particularly effective for those with obstructive symptoms. It is not used as often these days as more efficient modern procedures offer quicker treatment and recovery.
Prostatic urethral lift (PUL)
As the prostate grows, it compresses the urethra creating restriction in flow. With this procedure, first performed in Ireland at Tallaght in 2017, the surgeon inserts implants or tags that pull and hold the prostate away from the urethra thereby reducing the compression / blockage and improving the urine flow. This is an increasingly popular choice as it has a much lower incidence of reduced sexual function post procedure than TURPS.
Water / Steam ablation
A relatively new treatment for BPH, the procedure involves injecting water / steam at high pressure through a urethral probe into the prostate. Prostate tissue is destroyed by the high pressure thereby reducing the size of the prostate. The benefits of this choice are a reduction in potential side effects over a more invasive procedure such as TURPS. It can be done in a day hospital, without a hospital stay, resulting in a speedier return to normal activity.
This process acts in much the same way as water /steam ablation, only the water is replaced by a laser. The laser vaporises prostate tissue and cauterises at the same time, so this procedure may be suitable for those on blood thinning medication.
Open or robot-assisted prostatectomy
This procedure removes the prostate gland completely. The choice for either procedure is largely dependent on individual situations. Whilst completely effective, patients will need to restrict activity with no lifting for at least six weeks
Some older procedures such as Transurethral needle ablation (TUNA) and Prostate artery embolization are rarely used now since the advent of more efficient ablation procedures.
With increasing awareness through education, it is likely that in the future, men will become more comfortable with taking early action to have regular prostate checks when visiting GP form a much earlier age. As discussed at the outset and is the case with most conditions, earlier discovery enables earlier positive action which enables outcomes that will improve overall quality of life for longer.
For comprehensive and free health advice and information call in to Whelehans Pharmacies, log on to www.whelehans.ie or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).