- What is BPH?
- Prostatic Arterial Embolisation (PAE)
- Transurethral Resection of the Prostate (TURP)
- Urolift Procedure
- Plasmakinetic TURP (TURIS system)
- Holmium Laser Enucleation of the Prostate (HoLEP)
A patient's story
- How we helped a patient with BPH
What is BPH?
The prostate gland is an organ found in men, surrounding the neck of the urinary bladder. The gland grows with age, but if it grows too big, it can exert pressure on the urethra (tubes that drain urine) and may obstruct the flow of urine. This condition is called benign prostatic hyperplasia or hypertrophy (BPH) and causes urinary problems, such as difficulty in emptying the bladder and frequent urinary infections.
As men get older, the prostate will get larger due to the size of the cells inside the gland swelling. This can put pressure on the urethra (the tube you pass urine through). As a result, it can make it difficult to pass urine or even empty the bladder completely. Over a period of time, this can lead to damage to the bladder and kidneys, which is why it is important to seek the advice of a medical professional as soon as you realise you have an issue.
Treatment isn’t always required, but it can help to relieve symptoms and decreases the chance of problems with your bladder or kidneys in the future.
If symptoms are mild, then it may be best to see if they become worse before opting for treatment or considering which treatment might be best.
There are medicines available that can shrink the prostate or relax the prostate muscles, but these are temporary and if a person stops taking them, the symptoms will return. Furthermore, they are not always effective.
Prostatic Arterial Embolisation (PAE)
PAE uses an endovascular technique to shrink the prostate. The purpose of the treatment is to relieve the urinary symptoms associated with BPH. AUA offers careful assessment including CT angiography and in suitable patients, this treatment is performed by a highly skilled radiologist.
The potential benefits of prostate artery embolisation compared with surgery include fewer complications, avoiding a general anaesthetic and it may be done as a day case procedure.
Transurethral Resection of the Prostate (TURP)
This uses a telescope passed down the urethra to cut away prostate tissue causing an obstruction to the urinary flow with an electric loop. It is performed in men with BPH (benign prostatic enlargement) to improve urinary flow or to prevent complications of BPH such as recurrent urinary infections, bladder stones and kidney damage. A catheter is temporarily placed after the procedure.
The UroLift ® System treatment is a revolutionary, minimally invasive procedure. It works by lifting or holding the enlarged prostate tissue out of the way so it no longer blocks the urethra. There is no cutting, heating or removal or prostate tissue. Clinical data has shown that the UroLift System treatment is safe and effective in relieving lower urinary tract symptoms due to BPH without compromising sexual function. The goal of the UroLift System procedure is to relieve symptoms so you can get back to your life and resume your daily activities. The UroLift System procedure is NICE recommended.
The UroLift System procedure is a short procedure that is performed by a Urologist. The Urologist places tiny implants to hold the prostate lobes apart, like open curtains on a window, to relieve compression on the urethra. This allows urine to flow normally again. The UroLift System procedure is generally a day case procedure which is carried out under local anaesthesia +/- sedation. Typically, patients return home the same day without a catheter.
The UroLift System is an alternative for patient’s looking for something other than drug therapy or more invasive surgery. The procedure might be right for you if any of the following apply to you:
- You do not want to take another pill every day.
- You have tried BPH medication but are unhappy with the side effects.
- You do not want to undergo major surgery due to potential surgical risks of side effects and complications.
- You want a BPH solution that preserves your sexual function
- You want to regain your quality of life with minimal downtime.
Most common side events reported include haematuria, dysuria, micturition urgency, pelvic pain and urge incontinence. Most symptoms were mild to moderate in severity and resolved within two to four weeks after the procedure. This procedure is not suitable for everyone and nearly all patient will need a telescope test to look at the prostate to check if they are suitable.
Plasmakinetic TURP (TURIS system)
Similar to a standard TURP, this uses a plasmakinetic energy to cut or vaporise benign prostatic tissue. The irrigant fluid is saline and this means that the procedure is well suited to men with large prostates, as it allows more tissue to be removed.
Holmium Laser Enucleation of the Prostate (HoLEP)
Again similar to a standard TURP, HoLEP uses energy from a laser to cut or vaporize benign prostatic tissue. The irrigant fluid is saline and this means that the procedure is well suited to men with large prostates and it allows more tissue to be removed. It is performed under general or spinal anaesthesia. A doctor inserts a narrow telescope-like instrument into the penis and advances it through the urethra. A high-powered laser is passed through this instrument. The obstructing prostate tissue is carefully separated from its surrounding tissue using the laser and pushed into the bladder. A surgical instrument is then inserted through the telescope to suction out the excised prostate from the bladder.
The doctor may insert a catheter (thin tube) to drain the urinary bladder and leave it in place for a few days until recovery. Sterile saline fluid may be passed through the catheter to irrigate the bladder of any blood in the urine and prevent the formation of clots.
You may have to stay overnight in the hospital after the surgery and may be advised to drink more fluids for a week to help flush blood out of the urine more quickly. It is expected that you can resume your daily activities within a week.
A patient's story
How we helped a patient with BPH
Following blood tests for high cholesterol in 2014 my GP noticed that my PSA count was raised. It was decided to monitor the PSA levels as a precautionary measure. I was also finding fine debris occasionally when urinating. The raised levels continued such that I had a biopsy of my prostate in December 2014 but no sign of cancer was detected and I was diagnosed with age-related Benign Prostate Hyperplasia. Although I had no need to urinate more frequently and wasn’t needing to urinate during the night I started to pass what turned out to be small bladder stones and began to find urinating was taking longer than it had previously.
In December 2016, I was referred to a consultant urologist who confirmed that my prostate was around 150 ml in size and that the bladder stones were becoming larger. The consultant, a Mr. V, recommended that I have the bladder stones removed and then an operation to reduce the size of the prostate – the Holmium Laser Enucleation of the prostate -” The Gold Standard” as he called it. I decided to opt for a less invasive procedure and had just the bladder stones removed in February 2017 in the hope that they would not recur for a long time ! About a year later an ultrasound investigation confirmed that the bladder stones were back with a vengeance.
Consequently, I made an appointment to see Mr Sam Datta who worked privately out of the Oaks Hospital in Colchester. I had heard very positive reports about this particular gentleman and was happy to progress matters with him. I asked Mr Datta about the feasibility of carrying out a PAE procedure on my very enlarged ( now 175 ml )prostate which involves injecting beads into the arteries feeding the prostate and this reduces the blood flow to the gland hence causing it to shrink. Mr Datta was of the view that, as my prostate was now very large, this procedure would not be particularly effective. We had one last try at attempting to reduce the prostate in size via medication which I went on for about 6 months but the net effect was minimal and I reluctantly agreed to go for the Holep operation through Mr Datta, which took place in early June 2019.
The operation went well and after a couple of days I was sent home with a “bag” for a couple of weeks – I am 71 and it was a lengthy – 3 hours plus operation – hence the bag to ensure no infection might occur. I had two further consultations with Mr Datta – the last one being in early January this year when we agreed everything was fine and I should be discharged. I have had no ill effects whatsoever from the procedure – my PSA readings are very reduced and my urine flow is like that of a twenty year old.
I am back to leading a perfectly normal life with no issues regarding incontinence, impotence etc. I cannot recommend Mr Datta highly enough for his professional, measured and caring approach. He indulged all my other attempts to avoid invasive surgery and when I realised that such an approach was no longer viable ensured that his Holep procedure gave me an excellent outcome.