When should I consider surgery?
1. When your lower urinary tract symptoms get worse, even if you are already receiving drug treatment
2. When you have complications of BPE/BPH or if youare at risk of getting them. Complications include:

3. If you do not tolerate drug treatment very well
4. If you prefer surgery over drug treatment(due to poor compliance with drugs)

Duringmost of the surgical treatment, the urologist, willremove the enlarged part of your prostate (also known as adenoma). There are different types of surgical procedures, but all of them aim to relieve your symptoms and improve the flow of urine.

The main procedures are:

Each procedure has its own advantages and disadvantages. The choice of treatment depends on your individual situation, preference and expertise of a surgeon.This section offers brief information about various conventional surgical treatments and detailed information about laser treatment for benign prostatic enlargement.

TURP is the standard surgery for BPE/BPH. The aim is to remove the part of the prostate which causes the symptoms. The procedure is done through the urethra without making an incision in your lower abdomen. This type of surgery is known as minimally invasive treatment.

TUIP is effective in men with prostates smaller than 30gms. TUIP is recommended if you cannot tolerate drugs for BPE symptoms.During TUIP, the doctor cuts into the prostate through the bladder neck to improve the flow of urine.

Prostate stents are used to keep the urethra open which improves the flow of urine.Stents are mainly recommended for men who are not fit for surgery but who are still able to empty the bladder on their own. They are used instead of an indwelling catheter.

Open prostatectomy is an operation which is done by making an incision in the lower part of the abdomen. Because TURP/Laser prostatectomy has similar or better results, open prostatectomy is very rarely done in selected situations.

Laser treatment is a common treatment option for BPE/BPH. The laser uses intensive light to cut or vaporize the prostate tissue. At the same time, the heat from the laser is used to close blood vessels. This is why only a small amount of blood is lost during this type of surgery.
There are two main types of laser surgery for BPE:

These types of surgery can be done with different laser systems. The choice of the laser depends on the expertise of your doctor and what is available in the hospital.

How is laser vaporization performed?

For laser vaporization, patient will receive general or spinal anesthesia. Once patientare under anesthesia, the doctor uses a resectoscope to enter the bladder through the urethra without making an incision in your lower abdomen. The resectoscope has a laser for vaporization and a small camera.

During the procedure, the laser heats up a small part of the prostate. When the tissue reached boiling point it starts to vaporize. In this way, the whole prostate can be treated. After the operation, a urinary catheter will be placed in your bladder to drain urine. You will need the catheter for one or two days until the urethra is partly healed and you can urinate on your own.

When should I consider laser vaporization of the prostate?

Vaporization may be an option if your prostate is smaller than 80 to 100gms. Because vaporization causes very little blood loss, it is recommended for men who need to take blood-thinning medication for other conditions.

How long will it take me to get back to my daily activities?

Usually patient can leave the hospital 1 or 2 days after surgery. The length of hospital stay can vary in different situations. There may be some blood in your urine and you may feel pain when you urinate. This can last up to several weeks and not considered abnormal after such kind of surgery.

What are the advantages of laser vaporization of prostate?

• Immediate improvement of the urine flow
• Short hospital stay
• Shorter period of using a catheter
• Low risk of complications
• No need to stop blood-thinning medication

Disadvantages of laser vaporization

• Less effective for very large prostates
• Painful urination for some time after the surgery
• May need another surgery after several years because the prostate continues to grow
• No possibility to analyze the prostate tissue after the surgery
• Very low risk of urinary incontinence

Laser enucleation of the prostate

How is laser enucleation performed?

For laser enucleation,anesthesia,position of patient and instruments are the same as laser vaporization of prostate. It requires a different laser(i.e. holmium or thulium laser) compared to laser vaporization(i.e. KTP laser).During laser enucleation, the urologist uses the laser to cut prostate tissue and in this way the whole prostate can be treated. The doctor then uses an instrument known as morcellator to flush the cut tissue out of your body through the bladder and the urethra.

Postoperative management and stay remains same as in laser vaporization of prostate

When should I consider laser enucleation of the prostate?

If your prostate is over 80 to 100gms, laser enucleation may be the best option for you, because it removes the whole adenoma. This type of surgery is also a good option for men with prostates smaller than 80-100gms.
Laser enucleation is suitable for men who take blood- thinning medication for other conditions. It is important to discussy our individual situation with your doctor.

Advantages of laser enucleation

• Immediate improvement of the urine flow
• Short hospital stay
• Shorter period of using a catheter
• Low risk of complications
• Effective for all prostates, especially for large ones
• Possibility to analyze the prostate tissue after the surgery

Disadvantages of laser enucleation

• Painful urination for some time after the surgery
• Very low risk of urinary incontinence