Enlarged prostate surgery Toowoomba

Enlarged prostate

What treatments are available to relieve your symptoms?

What is an enlarged prostate?

A healthy prostate is about the size of a walnut whereas an enlarged prostate can be the size of a lemon. For most men, the prostate gland – often shortened to ‘prostate’ – grows with age. An enlarged prostate, also called benign prostatic hyperplasia or BPH, can cause problems with your ability to pass urine.

Your prostate is located just below the bladder and surrounds the urethra, which is the tube that carries urine from the bladder out of your body (like a doughnut with a hole in the centre – the doughnut being the prostate and the hole the urethra). When your prostate enlarges, it can squeeze the urethra, leading to a range of symptoms such as poor flow or a sensation of not fully emptying the bladder.

It’s important to emphasise that an enlarged prostate is not prostate cancer. Nor does it mean you’re at an increased risk of developing prostate cancer. Even though it’s a benign condition, it may have a serious impact on your quality of life if left untreated.

How common is enlarged prostate?

It’s fair to say that BPH is a normal part of ageing men: nearly all men will have it at some stage in their lives. In Australia, around 5 in 10 males older than 50 and more than 8 in 10 men older than 80 have symptoms of BPH.

What is the role of the prostate gland?

In short, the prostate gland produces a fluid that mixes with sperm cells during ejaculation. This fluid helps nourish and protect the sperm, increasing their chances of successfully fertilising an egg. The prostate also aids in ejaculation, helping propel the semen out of the body through the penis. Lastly, the prostate gland acts as a protective barrier around the urethra making sure that only urine or semen flows through it, preventing them from mixing.

What are the symptoms?

Poor urine flow is often the main symptom and a reason to book an appointment with a urologist. Some men, however, don’t have symptoms or have other symptoms.

Here are some common symptoms associated with BPH:

A weak urine flow (the flow deteriorates or stops and starts)
Difficulty starting urination
Dribbling at the end of your stream
Waking up at night to pass urine
Sensation of incomplete emptying of your bladder
Urgency – unable to hold on or needing to go when you need to go
Frequency – needing to pass urine often
Urine tract infections
Blood in the urine
Inability to pass urine

If you experience any of these symptoms it is worthwhile making a GP appointment or seeing a urologist. You need to seek emergency medical care if you suddenly find yourself unable to pass urine. This can lead to serious complications including kidney damage.

Causes and risk factors

Unfortunately, the exact causes of BPH are not fully understood. As you age, your hormone levels change, and this may be connected to developing an enlarged prostate. Family history may play a role as well. There appears to be a genetic component in the development of BPH. Lastly, lifestyle factors have an impact as well. Obesity, lack of exercise and smoking are associated with an increased risk of developing BPH.

How is an enlarged prostate diagnosed?

If you have any of the urinary symptoms listed above, your GP may refer you to see a urologist.

We will determine your BPH symptoms with a symptom assessment. You will be asked some questions, and based on your answers you will receive a score: mild – moderate or severe symptoms. We will also get you to perform a uroflow study (passing urine in a device) to evaluate the extent of the problem. We ask you to come with a full bladder to perform this test on your initial visit. Please let our staff know and they can do this test while waiting to be seen.

We will also take a medical history, may perform a physical examination and do some blood and urine tests. Sometimes a biopsy is taken or an ultrasound is done. The purpose is to rule out other types of prostate disease, such as prostatitis or prostate cancer.

Non-surgical treatment options for enlarged prostate

First-line treatments for BPH involve:

Lifestyle changes including but not limited to
- Regular exercise
- Maintaining a healthy weight
- Stop smoking
- Urinating when you feel the urge
- Limiting coffee and alcohol intake

Medication:
- Alpha-blockers e.g. prazosin, tamsulosin, silodosin.
- A combination of alpha-blockers and 5-alpha reductase enzyme inhibitors e.g. tamsulosin and dutasteride combination.

What are alpha-blockers?

Alpha-blockers work by helping relax the smooth muscles in the prostate, improving urine flow. This makes it easier for you to pass water and relieve symptoms.

What are 5-alpha reductase enzyme inhibitors?

5-alpha reductase enzyme inhibitors work by blocking the conversion of testosterone to dihydrotestosterone (DHT), a hormone that contributes to prostate enlargement. 5-alpha-reductase inhibitors can shrink the prostate gland over time, relieving BPH symptoms.

Surgical treatment options for enlarged prostate

Minimally-invasive procedures

Minimally invasive procedures as the name suggests reduce the sexual side effects eg ejaculation, erectile dysfunction while still providing good symptom relief.

UroLift

The UroLift System or prostatic urethral lift is a minimally-invasive procedure and an alternative to medication or surgery. One of the main benefits of this procedure is that it is not causing new and lasting erectile and ejaculatory dysfunction*.

The prostatic urethral lift in more detail

Prostatic urethral lift is typically performed as a day procedure. We will insert a scope through the obstructed urethra to visualise the enlarged prostate. Then, small implants are permanently placed into the prostate tissue to lift and hold it out of the way of the urethra (like pulling the curtains open). This increases the opening of the urethra.

The implants are intended to be permanent. They are made of a nitinol capsular tab, a stainless steel urethral tab and a polyethylene terephthalate suture that holds the two tabs together. Clinical studies have proven durability out to five years. Around this time the prostate can grow around the implants and may cause recurrence of symptoms. See “What can I expect after the urethral lift procedure?”.

What can I expect after the prostatic urethral lift procedure?

Most patients do not need a catheter after having the UroLift System procedure. The most common side-effects resolve within two to four weeks They include:

Painful urination
Blood in the urine
Pelvic pain
Urinary urgency
Inability to control the urge
Rare side-effects include bleeding and infection and may require intervention.

Most patients will have a lasting symptom relief from the procedure while maintaining their erections and ejaculatory function. Some may need a second procedure in the future if the prostate grows around the implant.

It is possible to have another procedure later down the track, including another UroLift, water vapour ablation, TURP or laser procedure.

When can I resume my day-to-day activities?

Usually, you go home the same day or the next day. You can resume normal activities relatively quickly compared to more invasive options, often a few days following the procedure. Some patients may start to experience relief from their BPH symptoms two weeks after the procedure; in other cases, it takes a bit longer (up to four weeks after the procedure).

How long does it last?

Clinical studies have demonstrated that UroLift can provide durable symptom relief and improved urine flow for up to five years. Longer-term follow-up studies are ongoing to assess its effectiveness beyond this timeframe.

Water vapour therapy:

Water vapour therapy is another minimally invasive treatment option to treat symptoms of enlarged prostate. The main benefit of this treatment option is that it uses the body’s natural response to heat and the absorption of water vapour to achieve prostate tissue shrinkage. Studies also confirm that water vapour therapy preserves sexual function**.

Water vapour therapy in more detail

Essentially, water vapour therapy is steam treatment for large prostates. There are no implants and ‘cutting’ is not necessary.

Typically, this procedure is performed under general anaesthesia. We will insert a scope or thin tube with a camera through the urethra to access the prostate and determine where to inject the steam to treat the extra tissue. We then use a special device, called the Rezūm System, to pass a needle into the enlarged prostate tissue. Then the system delivers controlled bursts of heated water vapour directly into the tissue, allowing it to be absorbed by the prostate cells. If your prostate is large, you will need more steam. The more steam you need, the more your prostate will swell after treatment. The water vapour procedure only takes around 15-30 minutes and most patients usually go home the same day.

Initially, the swelling makes your symptoms worse which is perfectly normal. But as your body starts to heal, your symptoms will improve. It takes around 3 months to fully heal.

What can I expect after water vapour therapy?

A catheter will be inserted into your bladder to enhance your comfort. The catheter may be connected to a drainage bag or equipped with a valve that allows you to open and close it when using the toilet. The catheter is typically left in for a week.

It is common to experience some discomfort in the bladder and at the tip of the penis due to the presence of the catheter. Over-the-counter pain medications can be used to alleviate this discomfort.

When you return to have the catheter removed, a week after the procedure, the nurse will ensure that you are able to urinate on your own before you are discharged. In case you are unable to urinate independently at that time, the catheter will need to be reinserted until the swelling settles down.

Once the catheter is removed, your symptoms usually get slightly worse. It’s important to be patient as your body is healing naturally and this can take time. By six weeks, most men notice relief of their symptoms.

We will give you some tips and tricks to ease your symptoms but it is important to drink plenty of water. Avoid caffeinated coffee/tea and alcohol for the first few weeks, as these drinks may make your symptoms worse.

When can I resume my day-to-day activities?

You can return to work as soon as you feel comfortable to do so. Some men return to work within a few days. Avoid strenuous exercise and lifting for the first few weeks though.

How long does it last?

Clinical studies have shown that the benefits of water vapour therapy can last up to five years. It provides durable symptom relief and improvement in urine flow over an extended period.

Invasive procedures

GreenLight

This procedure is also called photoselective vapourisation of the prostate and uses laser technology to precisely remove excess prostate tissue that is causing urinary obstruction. Compared with traditional surgical options, this type of laser therapy significantly reduces the chances of severe blood loss. Typically, with one night stay, allowing faster recovery.

The photoselective vaporisation of the prostate in more detail

Photoselective vapourisation of the prostate is typically performed under general anaesthesia. Once you’re asleep, we will insert a small scope into your urethra. This scope, which is a thin tube with a camera on the end, allows us to see the inner surfaces of the urethra, prostate and bladder.

Once the scope is positioned, we will insert the laser device through the scope to the location of the enlarged prostate tissue.

We will then vaporise the prostate tissue that is obstructing urine flow. Dead tissue that is not immediately vapourised will naturally pass through your urine in the initial days following the procedure.

A temporary urinary catheter may be placed at the end of the procedure to let urine drain from your bladder.

Most patients go home the next day. A urinary catheter is placed in your bladder at the end of the procedure, it will typically be removed within 24 hours. In some cases, it may take longer than 24 hours.

What can I expect after the GreenLight procedure?

Most patients experience rapid relief of symptoms and a significant improvement in urine flow, often within 24 – 72 hours of the procedure. However, individual experiences may vary.

Some patients may experience mild discomfort, such as a slight burning sensation during urination, and notice small amounts of blood in their urine for about a week. These symptoms should gradually resolve.

Depending on the condition of your bladder, you may experience greater frequency and urgency to urinate initially. However, this is expected to improve over time as your bladder adjusts.

When can I resume my day-to-day activities?

In general, most patients can return to their regular activities shortly after the procedure. However, it’s essential to follow our guidance regarding specific activity restrictions or recommendations based on your individual case.

How long does it last?

Clinical studies show that GreenLight laser treatment offers lasting symptom relief for at least 10 years and even longer.

TURP

TURP or transurethral resection of the prostate is another surgical procedure to remove the prostatic tissue obstructing the flow of urine.

TURP in more detail

Transurethral resection of the prostate is performed under general anaesthesia. Once you’re asleep, a small scope will be inserted into your urethra to visualise the inner surfaces of the urethra, prostate, and bladder.

After positioning the scope, a resectoscope, rather than a laser device, will be inserted through the scope to reach the location of the enlarged prostate tissue.

During the TURP procedure, the obstructing prostate tissue will be resected (cut out) and removed using a resectoscope. The tissue that is resected will be sent for further examination. Any residual dead tissue or small blood vessels may be cauterised to control bleeding.

A temporary urinary catheter is inserted at the end of the procedure to allow urine to drain from the bladder.

After the procedure, most patients are discharged within a few days, although the exact duration of hospital stay may vary. It is important to arrange for someone to pick you up after the procedure. If a urinary catheter was inserted, it is typically removed within 48 hours, but it may take longer in some cases.

What can I expect after the TURP procedure?

Most patients experience fairly quick relief of symptoms, often within a few days of the procedure.

Immediately after the procedure, you will spend a few hours in the recovery area. A urinary catheter is inserted during the procedure and remains in place for a short period to allow urine drainage.

The first few days after the procedure it is not uncommon to experience some mild discomfort, such as a burning sensation during urination. You may also notice small amounts of blood in the urine. We may prescribe some pain medications and antibiotics, if necessary, to manage any discomfort and prevent infection.

When can I go home and when will I see you for a follow-up?

Once you’re at home, typically after 2 days, we advise you to drink plenty of water, take your ural sachets three times a day for 48 hours, and use a stool softener to avoid constipation.

You will see your urologist again in our rooms two to three weeks after surgery. Make sure you have a full bladder for a flow rate on arrival.

When can I resume my day-to-day activities?

Most patients can gradually resume their normal activities within a few weeks after TURP. However, we advise you to avoid heavy lifting, vigorous exercise, and activities that put pressure on the surgical area until we give you clearance.

How long does it last?

Some studies have reported long-term benefits lasting up to 10 years or more.

Toowoomba Specialists for BPH

If you worry about an enlarged prostate, it is important to see a urologist. Even though it is a benign condition, you may experience discomforting symptoms that affect your daily life. The good news is there are many treatment options to help you.

At Toowoomba Specialists, our team of experienced urologists, specialise in the diagnosis and treatment of enlarged prostate. We offer advanced medical interventions, including minimally invasive procedures and surgical options. Ask your GP for a referral and contact Toowoomba Specialists today to schedule a consultation.

*
AUA BPH Guidelines 2003,
McVary, J Urol 2016;
Roehrborn et al. Can J Urol 2017;

**
https://www.bostonscientific.com/content/dam/bph/images/promo/URO-1232504-AA-rezum-5-year-Clinical-Summary.pdf

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Enlarged prostate surgery Toowoomba