Benign Prostatic Hyperplasia

In many men this enlargement causes symptoms commonly referred to as lower urinary tract symptoms (LUTS).  Symptoms include: The slowing of the urinary flow, the feeling of incomplete emptying of the bladder, the urgent need to urinate, the need to urinate many times at night, difficulty in starting to urine, dribbling at the end of the stream and on occasions blood in the urine.

Sometimes symptoms are tolerable and can be managed conservatively by modifying ones drinking habits and monitoring the condition.  When symptoms are bothersome treatment can be considered. Treatment may include:

Medical Therapy

  • Alpha blockers are medications that relax the smooth muscle fibers around the neck of the bladder and prostate allowing the pressure restricting the urethra to relax and relieve the obstruction to the flow of urine.
  • 5 Alpha Reductase Inhibitors (5ARI’s) are medications that reduce the effects of testosterone on the prostate and lead to reduction in the size of the prostate, but they may take several months to show benefit.
  • A combination of the above drugs is commonly used to increase the benefits.
  • Other drugs can be used to relax the bladder to help relieve some of the irritative symptoms.

Surgical Treatment

Transurethral Resection of the Prostate (TURP)

This is an operation where the inner part of the prostate gland is removed to relieve the obstruction. The aim of this operation is to hollow out the inside of the prostate to enable  a larger channel to be created for the passage of urine.   This procedure is carried out through a small operating telescope passed through the urethra. This procedure is carried out under a general or spinal anaesthetic.  At the completion of the procedure a catheter is inserted in the urethra and will remain there for 1 or 2 days.  The patient remains in hospital for this period.  After the operation it is common for the patient to experience some intermittent bleeding, stinging on urination and some urgency for a few weeks as the surgical area heals, however it is not serious and usually settles. 

A TURP is not an operation performed to treat prostate cancer, however the tissue removed during this procedure is examined histologically and sometimes cancer may be detected.

Laser ablation of the prostate

This is a newer technique, similar to the TURP  it also aims to enlarge the urine channel through the prostate.  This technique uses laser energy to vaporise the water in the prostate cells to create this cavity.  As the tissue is vaporised there is no tissue removed during this procedure.  The benefit of this procedure over the conventional TURP is that the laser seals the blood vessels as it creates the cavity and this results in significantly less bleeding. The catheter remains in the urethra for only 1 night and the patient is usually discharged from hospital the morning after surgery.  Dr Lazzaro performs Laser Ablations using The Greenlight ™ and Evolve ™ Lasers.

A common side effect of both TURP and Laser ablation of the prostate as well as most other surgical procedures on the bladder neck is retrograde ejaculation.  This is where there is absence or reduced ejaculation after climax as the seminal fluid remains in the lower urinary tract and comes out later in the urine.  This does not cause any harm.