BPH Surgical Treatment Options: TURP vs HoLEP
Enlarged prostate, also known as benign prostatic hyperplasia (BPH), can cause significant discomfort and inconvenience for men over 40. When medical treatments fail to provide relief, surgery may be necessary.
Two common surgical options for enlarged prostate are transurethral resection of the prostate (TURP) and holmium laser enucleation of the prostate (HoLEP).
Understanding TURP
Transurethral Resection of the Prostate (TURP)
TURP is a standard surgical procedure that involves removing part of the prostate gland.
The prostate gland is a small, walnut-shaped gland in men that sits just below the bladder and surrounds the urethra, the tube that carries urine from the bladder out of the penis.
As men age, the prostate gland can become enlarged, which can cause problems with urination.
It's typically recommended for men experiencing symptoms such as:
Urinary retention: This is the inability to completely empty the bladder.
Hesitancy: This is difficult to urinate.
Frequency: This is needing to urinate often, even at night.
Urgency: This is a strong feeling that you need to urinate right away.
Weak stream: This is a stream of urine that is weaker than normal.
Dribbling: This is leaking urine after urination.
Surgical procedures : Transurethral Resection of the Prostate (TURP)
Anesthesia: You'll be either put to sleep (general anesthesia) or given medicine to numb your lower body (spinal anesthesia).
Looking at the prostate: A thin tube with a camera will be inserted through your penis to see your prostate.
Cutting the prostate: The doctor will use electric current to cut the enlarged part of your prostate into pieces and remove them.
Finishing up: The doctor will clean out your bladder and close the surgery.
Time: The surgery usually takes about 2 hours, but it can be longer or shorter.
Surgical procedures : Radical Prostatectomy
Anesthesia: You'll be put to sleep for this surgery.
Cutting: The doctor will make a small cut near your belly button or a bigger cut in your lower belly.
Removing the prostate: The doctor will take out your prostate and some surrounding tissue.
Closing: The doctor will stop any bleeding, reconnect your bladder and urethra, and close the cut.
Drain: A small tube will be placed in your belly to drain fluid.
Time: The surgery usually takes about 4 hours, but it can be longer or shorter.
Important Note: The doctor may need to change the surgery plan during the procedure if something unexpected happens.
Recovery time is typically a few weeks, and common side effects include burning or pain during urination, blood in urine, incontinence (difficult to control your bladder, strong urge and leaks), and retrograde ejaculation (semen goes backward into the bladder instead of out of the penis).
These side effects are usually temporary and go away on their own. However, it is important to see your doctor if you have any concerns about your recovery.
Understanding HoLEP
Holmium Laser Enucleation of the Prostate (HoLEP)
HoLEP is a more recent surgical technique that uses a laser to remove enlarged prostate tissue. It was first developed in 1996 by Dr. Gilling and to date is a widely used surgical method in recent years.
HoLEP utilizes a novel Holmium:YAG laser to completely remove enlarged prostate tissue (transition zone, TZ). The Holmium laser has a shallow penetration depth of approximately 0.4mm, which is utilized for precise tissue ablation.
Derek Gearman, M.D., Urology, Mayo Clinic Health System, discusses HoLEP Procedure.
The prostate gland is divided into an outer capsule (peripheral zone, PZ) and an inner core (transition zone). Benign prostatic hyperplasia (BPH) occurs when the inner core (transition zone) enlarges. Notably, the prostate tissue is histologically separated by a thin membrane between the outer capsule and the inner core.
HoLEP takes advantage of this prostate tissue characteristic by using the Holmium laser to peel off the thin membrane, allowing for the complete removal of the enlarged inner core, the primary culprit of BPH.
The landscape of prostate enlargement surgery has undergone significant changes, leading to a wide range of patient experiences. Many patients who have undergone prostate surgery have negative perceptions about the procedure. These negative perceptions are primarily due to:
Severe post-operative bleeding causing significant patient discomfort and prolonged recovery times.
Incomplete removal of the prostate in transurethral resection of the prostate (TURP) procedures, often requiring patients to resume medication or undergo repeat surgeries within 3-5 years.
To address the issue of post-operative bleeding associated with TURP, innovative techniques such as KTP laser enucleation of the prostate and bipolar TURP were developed, which have significantly reduced bleeding complications. However, these procedures still leave residual prostate tissue, often leading to slower recovery times and the need for subsequent medications or surgeries.
To overcome the limitations of traditional procedures regarding bleeding and recurrence, HoLEP was developed. A key advantage and distinctive feature of HoLEP is the use of a Holmium:YAG laser (2,140nm wavelength), which virtually eliminates post-operative bleeding. Additionally, by completely removing the enlarged prostate tissue, HoLEP significantly reduces the risk of recurrence, earning it the nickname "the ultimate prostate surgery."
Why does HoLEP surgery have a low recurrence rate?
HoLEP (Holmium Laser Enucleation of the Prostate) is a highly safe surgical procedure with minimal recurrence, as it completely removes the enlarged prostate tissue.
The prostate gland is a reproductive organ in men, composed of five fused regions, similar to mulberry fruits. Three of these regions are mostly atrophied and not visible, while the remaining two regions, the transition zone and the peripheral zone, are the areas where prostate enlargement and prostate cancer occur. However, these two zones have distinct developmental origins and are separated by a thin, sturdy membrane.
By utilizing the Holmium laser along this membrane, HoLEP can effectively separate the transition zone from the peripheral zone. This is analogous to peeling off the pulp of a tangerine without leaving the rind intact.
Therefore, since the root cause of prostate enlargement, the "pulp" of the tangerine, is completely removed, the risk of post-operative recurrence is significantly reduced.
Many surgical procedures, such as transurethral resection of the prostate (TURP), KTP laser surgery, bipolar prostate surgery, and TURIS, are still widely used in many university hospitals. These procedures can be simply understood as "scooping out the inside of a pumpkin with a spoon."
However, HoLEP (Holmium Laser Enucleation of the Prostate) surgery is more like removing the pulp of a tangerine while leaving the peel intact.
Advantages of HoLEP Surgery Compared to Traditional Prostate Surgery
It's often considered a less invasive option with several advantages over TURP, including:
Minimal bleeding: HoLEP uses a holmium laser that seals blood vessels as it cuts, reducing blood loss.
Low recurrence rate: Complete removal of prostate tissue can help prevent future enlargement and the risk of recurrence. HoLEP procedure can be performed if there's a recurrence after other surgeries
Tissue acquisition for biopsy: Unlike other laser surgeries, HoLEP allows for tissue acquisition, enabling further pathological examination.
Suitable for large prostates: Even for very large prostates, HoLEP can be performed in a single procedure. Traditional methods may require multiple surgeries or extended hospital stays.
Faster recovery: Patients often experience less pain, can typically be discharged within 1-2 days post-surgery and return to normal activities earlier.
Simultaneous treatment for prostate enlargement and bladder stones: HoLEP can address both conditions in a single operation.
Comparable cost: The cost of HoLEP is similar to traditional prostate surgeries.
Choosing the Right Procedure
The best surgical option for you will depend on several factors, including the severity of your symptoms, your overall health, and your personal preferences. It's essential to discuss your options with your doctor to determine the most appropriate approach.
Choosing the Right Surgery
Key Differences Between TURP and HoLEP
| Procedure | TURP | HoLEP |
|---|---|---|
| Surgical Method | Electric cauterization to scrape away enlarged prostate tissue | Laser to completely remove enlarged prostate tissue |
| Surgical Complexity | More challenging and risky for larger prostate sizes | Can be performed regardless of prostate size, with minimal tissue damage and bleeding |
| Bleeding during Surgery | Higher risk | Lower risk due to simultaneous cutting and sealing |
| Suitable for Large Prostate | May require multiple procedures | Can handle larger prostates |
| Presence of Bladder Stones | Requires additional procedure | Can be removed during the same HoLEP procedure |
| Hospital Stay | 3-7 days | 1-2 days |
| Recovery Time | Longer | Shorter |
| Recurrence | Higher | Lower |
| Post-operative Pain | Present | Minimal or no pain |
“In summary, HoLEP offers several advantages over traditional prostate surgeries, including reduced bleeding, a lower risk of recurrence, the ability to obtain tissue for biopsy, suitability for large prostates, faster recovery time, and the potential to treat both prostate enlargement and bladder stones simultaneously, all at a comparable cost.”
Preparation for HoLEP procedures
HoLEP (Holmium Laser Enucleation of the Prostate) surgery typically takes 1-2 hours, and hospitalization is usually for 1-2 days. The catheter (urinary drainage tube) is typically removed 24 hours after HoLEP surgery.
1. Prostate Blood Test and Ultrasound Examination
2. Uroflowmetry and Cystoscopy
3. Surgical Explanation
4. Epidural Anesthesia (Spinal Anesthesia)
5. 1-Day Hospital Stay
6. Discharge. Return to normal life and activities in 2-3 days.
Post-Operative Care
Both TURP and HoLEP involve a brief hospital stay, typically 1-2 days. You'll likely have a catheter in place for a short time to drain urine. Recovery time varies, but most patients can resume normal activities within a few days up to weeks.
Conclusion
If you're experiencing symptoms of enlarged prostate and medical treatments haven't provided relief, surgical options like TURP and HoLEP may be appropriate. By understanding the differences between these procedures and discussing your options with your doctor, you can make an informed decision about the best course of treatment for your individual needs.
Do you have urinary issues?
Nighttime bathroom trips? Concerned about BPH? Check your urine flow at home with proudP.
*Disclaimer: This article is not intended to provide any medical advice. This information should not be relied upon as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified healthcare provider with any questions you may have regarding a medical condition.
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