Surgical treatment for benign prostatic hyperplasia

At alta uro, we decide which type of surgery for benign prostatic hyperplasia is right for each individual patient. We take plenty of time over our decision, as there are now many different surgical procedures available to treat this condition.

To choose the most suitable method for you, it’s important that we consider your specific situation as well as your preferences and expectations. We’ll then work together to choose the ideal approach.

When choosing a surgical procedure, alta uro looks at the following factors:

  • Nature of the symptoms and impact on quality of life
  • Size of the prostate as determined via ultrasound
  • Other current or previous conditions and any blood thinners taken
  • Extent of damage to bladder function
  • Desire to preserve ejaculation
  • Rezum water vapour ablation of the prostate
  • Desire to avoid anaesthesia

alta uro offers the following surgical procedures for benign prostatic hyperplasia:

All surgeries are performed at the Merian Iselin Clinic in Basel.

1. Bipolar transurethral resection of the prostate (TURP)

What is bipolar TURP?
This operation is carried out via the urethra and requires spinal or general anaesthesia. Prostate tissue is removed using an electrified loop fed through an endoscope. The tissue that is preventing the patient from properly emptying their bladder is removed to restore normal bladder function.

Who is this procedure suitable for?
TURP remains one of the standard procedures for patients with a prostate volume up to about 100 ml. It is a long-established method which has undergone technological advances in recent years. alta uro carries out all TURP operations using bipolar resection instruments to minimise the risk of bleeding. We also ensure that our patients are not at risk of TUR syndrome, a sometimes life-threatening change in the body’s salt levels — our irrigating fluid has an identical salt content to that of blood.

What are the advantages of this procedure?
The advantage of bipolar TURP is that it is one of the most well-established surgical procedures in urology as a whole. Numerous studies have proven it to be effective, long-lasting and safe.

What risks and drawbacks are involved?
Every procedure for the ablation of prostate tissue involves a certain risk of bleeding. Additionally, many patients are no longer able to ejaculate following surgery. There is a small risk that the urethra will narrow as a result of the operation. The tissue that is removed may also grow back. In rare cases, this means that further surgery will eventually be needed. The risk of urine leakage (incontinence) following the operation is very low.

2. Greenlight Laser Vaporisation

What is GreenLight laser vaporisation of the prostate?
GreenLight laser vaporisation is a tried-and-tested, minimally invasive technique for treating benign prostatic hyperplasia. The procedure involves using a high-powered laser to vaporise excess prostate tissue quickly and accurately. When the surgeon directs the laser beam at the prostate, the intense pulses of light emitted from the fibre are absorbed by the blood. The temperature of the blood quickly becomes so high that nearby cells are vaporised.

 

Who can benefit from GreenLight laser therapy?
GreenLight laser therapy is an option for nearly every patient with benign prostatic hyperplasia. In the hands of an experienced surgeon, even patients with above-average prostate volume (e.g. well over 100 millilitres) can be treated with GreenLight laser therapy. The laser is targeted very precisely so as to preserve as much of the surrounding structures as possible.

Welche Vorteile bietet dieses Verfahren?
Wissenschaftliche Untersuchungen konnten zeigen, dass nach einer Greenlight Laservaporisation der Prostata weniger Blutungskomplikationen auftreten als nach einer TUR-Prostata. Da der Laserstrahl das Gewebe verdampft und gleichzeitig verschorft, ist das Risiko einer Blutung sehr gering. Ein Vorteil des Greenlight Lasers ist, dass auch Patienten mit Blutverdünnung oder erhöhtem Blutungsrisiko sicher operiert werden können.

What complications are associated with GreenLight laser therapy?
Numerous scientific studies have shown that GreenLight laser vaporisation of the prostate is associated with fewer complications than prostate resection. Since the laser simultaneously vaporises and cauterises the tissue, the risk of bleeding is minimal. A significant advantage of GreenLight laser therapy is that it can also be safely used on patients who are taking blood thinners or have an increased risk of bleeding. Retrograde ejaculation (orgasm without the discharge of semen) is a common side effect of minor prostate surgeries. Thanks to a special technique, GreenLight laser vaporisation makes it possible to prevent this.

The advantages of GreenLight laser therapy at a glance:

  • Rapid relief of symptoms
  • Faster recovery after surgery
  • Safe for patients on blood thinners
  • Long-term treatment success
  • Preservation of important functions (continence and potency)
  • Preservation of ejaculation possible
  • Treatment is possible regardless of prostate size

3. Aquablation of the prostate using AquaBeam

What is aquablation of the prostate using AquaBeam?
AquaBeam is an innovative system for treating benign prostatic hyperplasia. A computer-guided jet of water is used to remove the excess prostate tissue. Like TURP, this operation is carried out via the urethra using an endoscope and requires patients to be anaesthetised. It does not use any heat or electricity, ensuring the best possible protection for the surrounding tissue.

The surgical robot guarantees the utmost precision in ablating the area previously determined by the operator. This precise, relatively conservative removal of tissue without the use of heat means that ejaculation can be preserved in many patients.

procept_aquabeam_system_with screen

Who is this procedure suitable for?
Aquablation is generally suitable for patients with medium-sized to large prostate glands. They should not be taking any anticoagulants. This procedure is very popular, particularly as it generally allows preservation of ejaculation.

waterjet

What are the advantages of this procedure?
A number of scientific studies have looked at aquablation, some of which compared outcomes to those for TURP. While the improvement in urination is comparable with both procedures, aquablation stands out in particular for the very high proportion of patients who retain sexual function and the ability to ejaculate. As no heat is used when removing tissue, only a small proportion of patients suffer irritation of the bladder following surgery.

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What risks and drawbacks are involved?
Aquablation is an innovative new surgical technique. This means that we do not yet have long-term data (covering more than two years) from comparative studies looking at aquablation and TURP. As a result, we cannot yet fully rule out the possibility that the preservation of tissue may in some cases lead to regrowth later on, eventually making a second operation necessary. Patients may experience bleeding after aquablation, but this risk is low with alta uro thanks to the routine performance of endoscope monitoring and active interventions to stem bleeding during surgery. The risk of urine leakage following aquablation is also very low.

4. Rezum water vapour ablation of the prostate

What is Rezum water vapour ablation of the prostate?
This minimally invasive procedure involves injecting sterile water vapour into the prostate tissue that requires treatment, while monitoring the surgery via endoscope. It focuses on the inner zone of the prostate — the area which causes the enlargement and therefore the symptoms experienced by the patient. When the water vapour comes into contact with the tissue, it returns to a liquid state and releases the heat energy which was stored in it.

rezum gerät

This energy acts directly on the cells in the area which is being treated. It damages these cells and breaks them down. This causes the prostate to shrink, meaning that patients are able to urinate normally again after a period of several weeks, depending on the size of the prostate. After treatment, patients are fitted with a urinary catheter which can be removed in a few days’ time.

rezum

Who is this procedure suitable for?
The procedure is particularly suitable for patients with a small to medium prostate volume, up to about 80 ml. As no tissue is removed, local anaesthesia or sedation can also be used; spinal or general anaesthesia is not necessarily required. The minimally invasive nature of the procedure and the fact that it does not impair ejaculation in most patients mean that it is also suitable for younger patients looking for a middle ground between medication and ablation surgery.

What are the advantages of this procedure?
As the heat does not spread beyond the prostate, it is extremely unlikely that patients will suffer incontinence. There is also virtually no effect on ejaculation. In addition, it is a very brief procedure, usually lasting no more than 10 to 15 minutes. As no tissue is removed, the risk of bleeding or setbacks caused by wound healing is minimal.

What risks and drawbacks are involved?
Long-term data are currently available on the effectiveness of Rezum over 4 years. These data show that the proportion of patients who required further surgery was around 5%. The number of patients who require further medication is also around 5%. Unlike other techniques, this surgery does not have an immediate effect — some patients will only begin to feel the benefits several weeks later. Depending on the prostate size, some patients will also require a urinary catheter for a few days.

5. Robot-assisted enucleation of the prostate using the da Vinci system

What is robot-assisted enucleation of the prostate using the da Vinci system?
If the prostate is extremely enlarged and, for example, the patient also has bladder stones or diverticula, it may be necessary to operate using the da Vinci robot. Small incisions will be made in the abdomen and the surgeon will then use the robot’s instruments to open the bladder and enucleate (cut out) the benign prostate tissue.

Who is this procedure suitable for??
The procedure is suitable for patients who have an extremely enlarged prostate, including those who have other damage to the bladder, such as bladder stones or diverticula (pouches in the bladder wall).

What are the advantages of this procedure?
As the benign prostate tissue is entirely removed, it is very unlikely that tissue will grow back. Large bladder stones or diverticula can also be removed at the same time.

What risks and drawbacks are involved?
As the surgeon accesses the prostate via the abdomen, patients generally need to stay in hospital for several days afterwards. They will also need a urinary catheter for around 5 to 7 days. Furthermore, there is a very low risk of injury to the surrounding structures. The risk of heavy bleeding following robot-assisted enucleation is low, and there is also a very low risk of urine leakage.

DO YOU HAVE ANY ADDITIONAL QUESTIONS ABOUT BENIGN PROSTATIC HYPERPLASIA? PLEASE DON’T HESITATE TO GET IN TOUCH.