Symptoms caused by benign prostatic enlargement are exceedingly common and become more common as men age. Evaluation is necessary to exclude prostate cancer, infection and back pressure damage to the kidneys and bladder. If the prostate obstruction is not causing harm, many men choose to live with the symptoms.
For many men, medications can be effective at helping symptoms. However, tablets may not work, or they may cause side effects, such as dizziness, nasal congestion or loss of erections. In this situation, and in men having complications of prostatic obstruction, an operation is required.
TURP (Transurethral Resection of the Prostate), also known colloquially as the ‘rebore’ is one the more common operations performed in the Western world.
It is done under a general or spinal anaesthetic as a minimally invasive operation using a telescope which removes obstructing prostate tissue. The TURP requires a 2-day visit to hospital. Recovery is usually rapid, though men do need to avoid heavy lifting afterwards for a month or so.
Many men these days are on strong blood thinners, usually because of previous heart problems. A TURP procedure requires stopping blood thinning drugs around the time of the prostate surgery. For men on strong blood thinners Greenlight laser surgery can be a better option. All blood thinners can continue and there is no bleeding intra-operatively and men usually go home the next morning. The chance of requiring repeat treatment is higher in men having Greenlight laser surgery on their prostate, in comparison to patients who undergo a TURP.
One problem with both TURP and Greenlight laser prostate surgery is that both are likely to cause a side-effect called retrograde ejaculation. The libido, erections and orgasm are retained, but there is no or little ejaculation. This doesn’t affect the quality of the orgasm, but clearly has an impact on fertility!
For men in whom this is a problem, a newer, minimally invasive procedure is available called a Urolift. It is a transprostatic implant device inserted through a telescope which tethers the prostatic channel open (between 2 and 6 usually deployed) relieving obstruction while retaining normal ejaculation. It is usually a day visit to hospital and men can return fully to normal activities in a couple of days.