Please note: This page is intended for healthcare professionals only. It is designed as a general educational guide and does not replace local guidance, senior clinical advice, or individual clinical judgement. Patients should not use this page as medical advice and should seek advice from an appropriate healthcare professional.
Prostate Operations
This is a very brief introduction into most common urological operations. The list below is not exhaustive of all urological operations, but the procedures an SHO will more commonly encounter.
⚠️ Postoperative care is procedure and patient-specific. Always read the operation note before taking any action. Instructions regarding catheters, drains, stents, antibiotics, anticoagulation, imaging, and follow-up may differ between patients.
Patient information leaflets
- Prostate procedures – HERE
Endoscopic Operations (BPH / LUTS)
These procedures remove only the obstructing part of the prostate, not the entire gland. The remaining prostate tissue can continue to grow (prostatic regrowth), so some patients may develop recurrent symptoms and require further treatment in the future.
TURP – Transurethral Resection of the Prostate
- Endoscopic operation for obstructive prostate. Resection loop removes obstructing adenoma ("chips") using diathermy
- Can be done using Monopolar (higher risk of TUR syndrome) and Bipolar energy
- Indications for TURP:
- Bothersome LUTS that cannot be sufficiently managed conservatively and medically
- Retention (acute, chronic, high pressure chronic retention)
- Prior to prostate radiotherapy to reduce the risk of complications in those with pre-existing LUTS/chronic retention (channel TURP)
- Prostatic abscess (TUR surgery is one of the options)
- Catheter 24–72 hrs; patients typical stay in 1–2 days
- Risks:
- Common – LUTS, haematuria, retrograde ejaculation
- Serious – bleeding needing transfusion or return to theatre, strictures, TUR syndrome (rare – read HERE), perforation, injury to ureteric orifices, incontinence
BNI – Bladder Neck Incision
- Endoscopic incision (not resection) at bladder neck
- Done with diathermy or laser
- Suited to small prostates, high bladder neck in younger men
- Catheter ~24 hrs
- Quick recovery
HoLEP – Holmium Laser Enucleation of the Prostate
- Called ThuFLEP if using Thulium laser
- Laser enucleation of the adenoma followed by morcellation
- Works for all prostate sizes, especially very large glands
- Less bleeding
- Durable long-term results
- Specific risks: transient stress incontinence
Greenlight Laser Prostatectomy (GLLP) / PVP
- Laser vaporises prostate tissue (Photoselective Vaporisation)
- Very good for patients with bleeding risk
- Day case; catheter 24–48 hrs
Aquablation
- Robot-guided water jet resection under real-time ultrasound control
- Good for large prostates
- Less thermal injury → may preserve sexual function
- Catheter 1–3 days
Rezūm – Water Vapour Therapy
- Can be done under LA and GA
- Steam injections cause prostate tissue necrosis; shrinkage over 4–12 weeks
- Office-based / day-case; catheter 3–7 days
- Preserves ejaculation
- Risks: transient LUTS flare, UTI, retention
PAE – Prostatic Artery Embolisation
- IR procedure: embolisation of prostatic arteries → gland shrinkage over weeks
- Good for patients unfit for GA or avoiding urethral instrumentation
- Less effective with median lobes or very large prostates
- Specific risks – pelvic pain, dysuria, incomplete response; rare cases – penile ulcer and necrosis
Urolift
- Permanent implants retract the lateral lobes to open the prostatic urethra
- No tissue removal
- Ejaculation preserved
- Day case; catheter rarely required
- Best for small–moderate glands, no median lobe
iTind – Temporarily Implanted Nitinol Device
- Nitinol device placed cystoscopically for 5–7 days to remodel the prostatic urethra
- Removed after 5–7 days
- Minimally invasive; limited long-term durability data
Prostatectomy (Complete Prostate Removal)
- Approaches:
- Laparoscopic / Robotic (abbreviated as RALP/RARP)
- Open
- Indications:
- Benign disease – simple prostatectomy
- Prostate cancer – radical prostatectomy
Simple prostatectomy:
- Indication – very large prostates, failed endoscopic options
- Open approach = Millins prostatectomy
- Removes the adenoma only, leaving the capsule in place
- Done very rarely nowadays due to other alternative procedures with less morbidity (such as HOLEP)
- Recovery:
- Greater bleeding risk than endoscopic procedures
- Stay 2–4 days
- Catheter remains 5–7 days
Radical prostatectomy:
- RALP / RARP is standard; open used selectively
- Removes prostate + seminal vesicles ± pelvic lymph nodes (PLND) for localised prostate cancer
- Patients go home with a catheter – removal timing follows strict operative note instructions
⚠️ Important Warning – if catheter falls out in early post-op period → DO NOT reinsert blindly. Contact SpR/consultant urgently → risk of disrupting vesico-urethral anastomosis
- Specific risks – this is a major operation – ileus, bleeding, lymphocele, anastomotic leak, bowel injury, hernias, urinary incontinence, erectile dysfunction
- Recovery – stay 1–2 days for robotic
Other Minimally Invasive Prostate Cancer Treatments
Brachytherapy:
- Internal radiotherapy delivered directly to the prostate for selected patients with localised prostate cancer
- Can be performed as permanent seed implantation (low dose, LDR) or temporary high-dose treatment (HDR).
- Minimises radiation exposure to surrounding tissues
HIFU:
- Minimally invasive treatment using focused ultrasound to destroy prostate tissue.
- Used in selected patients with localised prostate cancer, usually in specialist centres.
Prostate Biopsy
- Performed for suspected prostate cancers (elevated PSA or MRI-visible lesions)
- Usually done under LA, but can be done under GA
- Risks:
- Common – haematuria, blood in stool, haematospermia (latter can be for several weeks), retention, need for repeat procedure / further surveillance / treatment
- Serious – sepsis, clot retention
Approaches:
Transperineal (TP) Biopsy:
- Increasingly preferred due to lower infection risk
- Patients are in lithotomy position
- Needle passes through perineum
- Useful for MRI-targeted biopsies
Transrectal (TRUS) Biopsy:
- Ultrasound-guided biopsy via the rectum
- Patients in lateral decubitus position
- Higher infection risk → requires antibiotic prophylaxis