The choice of procedures available for benign prostate enlargement and urinary retention

Benign prostate enlargement (BPE), also known as benign prostatic hyperplasia (BPH), is a common condition affecting men as they age. It can lead to troublesome urinary symptoms, including difficulty starting urination, frequent urination, weak flow and urinary retention. Fortunately, several surgical options are available to address these issues, providing relief and improving quality of life.

What are the main surgical treatments for BPE and urinary retention?

Surgical interventions for BPE are chosen based on the severity of symptoms, the size of the prostate, and the patient's overall health. The main options include:

1. Transurethral resection of the prostate (TURP)
   • Considered the gold standard for BPE surgery, TURP involves removing excess prostate tissue through the urethra using a resectoscope.
   • Benefits: Rapid symptom relief, improved urinary flow, and effective treatment for moderate to severe symptoms.
   • Drawbacks: Risk of complications such as bleeding, infection, or retrograde ejaculation.
2. Holmium laser enucleation of the prostate (HoLEP)
3. • A minimally invasive procedure where laser energy removes excess prostate tissue.
   • Benefits: Suitable for larger prostates, less bleeding, shorter recovery time, and durable results.
   • Drawbacks: Requires specialised equipment and expertise.
4. Prostate artery embolisation (PAE)
   • A non-surgical procedure that blocks blood supply to the prostate, causing it to shrink.
   • Benefits: Minimally invasive, minimal risk of sexual dysfunction, and quicker recovery.
   • Drawbacks: May not be as effective as surgical options for severe symptoms.
5. Urolift System
   • A minimally invasive technique where small implants lift and hold the prostate tissue away from the urethra to improve urine flow.
   • Benefits: No cutting or tissue removal, quick recovery, and preservation of sexual function.
   • Drawbacks: May not be suitable for very large prostates or severe symptoms.
6. Open prostatectomy
   • A traditional surgical approach reserved for extremely large prostates. It involves making an abdominal incision to remove the enlarged prostate tissue.
   • Benefits: Effective for severe cases of BPE.
   • Drawbacks: Longer recovery time, higher risk of complications, and more invasive.

What are the key things to consider when choosing the right procedure for BPE?

The choice of treatment depends on several factors:

• Prostate size: Larger prostates may benefit from HoLEP or open prostatectomy, while smaller or moderate enlargements might respond well to TURP or Urolift.
• Patient health: Patients with bleeding disorders or other medical conditions may prefer minimally invasive options like PAE.
• Symptom severity: Severe urinary retention or complications like bladder stones may require more definitive surgical options.
• Lifestyle preferences: Patients prioritising quicker recovery or preservation of sexual function may opt for Urolift or laser-based procedures.

What’s involved in recovery and follow-up for BPE surgery?

Recovery times vary depending on the procedure. Minimally invasive techniques like HoLEP and Urolift often allow patients to return to normal activities within days. More invasive surgeries like TURP or open prostatectomy may require weeks of recovery.

Regular follow-ups are essential to monitor progress, address any complications, and ensure lasting symptom relief. Patients experiencing ongoing urinary retention or incomplete symptom resolution should consult their urologist to explore additional treatment options.

Choosing the right procedure is a collaborative decision between the patient and their healthcare provider, ensuring the best possible outcome tailored to individual needs.