Benign enlargement of the prostate gland is a cause of much misery in men. The gland, which surrounds the outlet of the bladder, commonly enlarges with age and it may interfere with bladder emptying and control. A special surgical technique (transurethral resection, known as “TURP”) enables the obstructing prostate to be removed surgically without external scars. This procedure was, by itself, the main stimulus to urology developing as a specialty over 50 years ago.
Nowadays, although TURP remains the most effective operation, we have a range of alternative treatments from tablets to laser surgery.
Investigating and treating patients with prostate symptoms takes up a large amount of a urologist’s time.
Management of Male LUTS
Mr Mark Speakman, Consultant Urologist in Taunton discusses the current thinking on the investigation and management of lower urinary tract symptoms (LUTS) due to benign prostatic enlargement.
Most patients would be considered for medical (drug) treatment in the first instance but, when secondary complications of outflow obstruction supervene, it may be necessary to consider surgery to relieve the obstruction and the complication(s).
(video courtesy of Mr Mark Speakman & "Trends in Urology")
Endoscopic video of TURP
The prostate gland is removed "piecemeal" using a wire loop which cuts by using a high-energy electric current. Lower-energy current is used to seal any bleeding blood vessels encountered during the procedure.
The prostate "chips" wash forwards into the bladder and are evacuated at the end of the procedure, leaving an open cavity & relieving the obstruction to urine flow.
(video courtesy of Mr KN Bullock)
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Holmium laser prostatectomy (HoLEP)
In this procedure, the prostate is "detached" from its surroundings using a laser fibre; the laser fibre also allows sealing of any blood vessels.
Once all the gland has been detached, it is pushed forwards into the bladder where it is morcellated ("chewed") into small fragments, which are then removed. This leaves a smooth, bloodless cavity where the prostate was.
(video courtesy of Mr TF Aho)
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To see more detailed information about prostate symptoms click here.