Enlargement of the prostate occurs in men above the age of 55-60 years. It is an age-related development like cataract, arthritis, wrinkling of the skin, greying of hair, etc.,
The symptoms of prostate enlargement are: weak stream of urine, interrupted urine flow, sense of incomplete urination, urgency, increased urinary frequency, and other symptoms.
The initial treatment of enlarged prostate is a medical treatment by tablets. It is very effective and safe. However, once they are discontinued, the symptoms recur. Also, some patients do not respond well to tablets. Some may find them expensive as they have to be taken life long and some people living in villages may have difficulty finding them. Some do not tolerate the side effects too.
These are the situations where surgery for the prostate helps.
Surgeries for the prostate:
1. TURP
The most common surgery and the gold standard is TURP. In India, more than 90% of prostate surgeries are TURP’s.
How is it done?
The patient is hospitalized and an injection is given in the back (spinal anesthesia). An endoscope is inserted through the penis and using electric current prostate is cut and pieces are removed through the endoscope. No cuts or stitches are made. At the end of the surgery, a catheter is kept and removed after 48 hours. The entire hospital stay is about 48 hours.
TURP is a time-tested, safe, and cost-effective. It is also available in every hospital.
2. LASER prostatectomy
The advantage of this procedure is that in grossly enlarged prostates, the blood loss is low as compared to TURP. The difference between LASER and TURP is the energy that is used to cut the prostate. In Laser surgery, a laser is used as energy but in TURP, electric current is used as energy.
There are many types of lasers. Holmium, Diode, Greenlight, and Thulium are the important ones. There are minor differences among them but the outcomes are dependent on the surgeon rather than the technology.
3. TUIP
In this surgery instead of removing the prostate, only an incision is made to enlarge the passage. This is done when the prostate is not very much enlarged and the patient is young and wants to preserve ejaculation.
4. Open prostatectomy
A cut is made on the skin to remove the prostate. With advances in endoscopic surgeries, this method is almost given up.
TURP versus LASER prostate surgery. Which is better?
TURP is good for prostates that are mild and moderately enlarged. Grossly enlarged prostates are better treated by laser surgery as the bleeding is less. Also in patients on anticoagulants (blood thinners) laser surgery is the preferred one.
To summarize:
Advantages of laser:
- Less bleeding
Advantages of TURP:
- Cheaper
- Time tested
- Less complications
- Widely available