BPH is a very common and natural condition that occurs as a man ages. About 50% of men will suffer symptoms related to BPH as they get older and about 20% will need medical or surgical intervention for BPH. There are a range of prostate surgery treatments available, each of which has benefits and possible side effects. Here at Gold Coast Urologist all of the latest and best techniques are on offer, however they need to be tailored to each patient based on their symptom severity caused by BPH, prostate shape and size, other medical conditions and obviously patient wishes.

 

The Gold Coast Urologist team has highlighted below the benefits and downsides of the possible prostate surgery treatments available to you for BPH and your prostate troubles.

Benign Prostatic Hyperplasia (BPH)

Urolift is a relatively new, minimally invasive technique designed to improve urinary symptoms caused by an enlarged prostate or BPH. Gold Coast urologist Dr Elmes, was one of the first surgeons in Queensland to perform it.

 

The procedure is carried out by inserting several small internal stitiches into the prostate, compressing the tissue outwards and thus widening the internal diameter of the 'urethra' (the tube we naturally urinate out).

 

It does not involve cutting or lasering of any of the prostate tissue and as such results in a far better side effect profile:

 

  • No Erectile Dysfunction

  • No stress urinary incontinence

  • No retrograde (backwards) ejaculation

 

 

However the improvement in flow strength and reduction of urinary symptoms  with UroLift is less than cavitating treatments such as Greenlight, HoLEP or TURP and the longevity of UroLift is also doubtful - some men get improvement for one year others up to five years.

 

Dr Elmes recommends urolift it to his patients with:

 

  • mild to moderate urinary symptoms who want to stop daily tablets

  • a fear of retrograde ejaculation

Download the UroLift Patient FAQs Brochure here

HoLEP (Laser prostate enucleation)

Holmium or thulium laser enucleation is the state of the art, platinum standard for BPH treatment. It is minimally invasive and follows the exact anatomical planes within a prostate with ultimate precision allowing complete resection of all adenoma (obstructing tissue) whilst preserving the outer capsule, erectile nerves and urethral sphincter.

 

Its short and longterm outcomes are superior to those associated with TURP:

 

  • less bleeding

  • lower chance of erectile dysfunction or incontinence

  • same maximal flow rate and urinary symptom improvement

  • minimal reoperation rate

 

and superior to greenlight (side firing) laser:

 

  • Importantly allows sampling of tissue to look for cancer

  • same low blood loss

  • lower chance of incontinence

  • greater improvement in flow rates and urinary symptoms

  • lower reoperation rate

 

Gold Coast Urologist Dr Elmes recommends HoLEP or ThulEP for all his patients with moderately to severely bothersome symptomatic BPH that have:

 

  • failed or do not wish to have medical therapy

  • are willing to tolerate retrograde ejaculation

  • that do not wish to undergo the older style TURP or re-bore

Robotic Enucleation of the Prostate 

In some men with severely enlarged BPH, surgery to remove a large section of prostate tissue from around the urethra is recommended. This helps with very enlarged prostates (eg, over 100 grams or so, about 3X normal size) or when BPH causes serious obstruction and problems such as urinary retention, infection, blood or stones (calculi) in the bladder, or kidney damage performed with the da Vinci® Surgical System in a minimally invasive procedure. Robotic techniques allow more precise removal of the inner part of the prostate with smaller incisions, reduced blood loss, less need for blood transfusion, less pain, shorter hospital stay (2-3 days), and faster overall recovery before a return to normal activities.

 

The exact approach and incision locations depend on the prostate's size and the patient's symptoms and other conditions. In most procedures, the adenoma (the abnormally enlarged portion of the prostate) near the urethra is carefully resected (removed). Then remaining parts of the gland are sewn back together to restore the normal prostate capsule.

Watch Dr Elmes perform a Robotic Enucleation of the Prostate

TURP or Re-bore

 

Transurethral resection of the prostate is a still a viable alternative for bladder outlet obstruction caused by BPH. It creates a wide open cavity using electrical energy to allow segmental cutting of of the obstructing prostate tissue which is then removed via the penis piecemeal.

 

It creates a very good improvement in flow and reduction of urinary symptoms and has done so for many years, however it has been recently superceded by advanced laser prostate enucleation (HolEP or ThulEP), which has:

 

  • lower bleeding/transfusion rate

  • lower erectile dysfunction rate

  • same improvement in urinary symptoms and flow rates.

© 2014-2019, Gold Coast Urologist, goldcoasturologist.com.au

Phone (07) 5575 7922

Fax (07) 5575 8922

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Varsity Lakes, Gold Coast, Australia