Benign prostatic enlargement (benign prostatic hyperplasia, BPH)
When is surgery advisable?
Benign prostatic enlargement (BPH) is a common cause of problems with urination and an increased urge to urinate. If medication no longer works sufficiently or complications occur, such as repeated urinary retention, bladder stones, significant residual urine, recurrent urinary tract infections, hydronephrosis or a threat to kidney function, surgery offers lasting relief. At the Goldstadt Private Clinic, the operations mainly use minimally invasive transurethral procedures without an abdominal incision – modern surgical procedures with short recovery times.
Symptoms of benign prostatic enlargement
What are the symptoms of benign prostatic enlargement? Benign enlargement of the prostate, also known as benign prostatic hyperplasia (BPH), can be detected in almost all men over 50. Important to know: it is a benign growth that is not dangerous, does not form metastases and does not grow into other organs. Benign prostatic enlargement only causes symptoms requiring treatment if the enlargement is located in an area where the urethra is constricted. In this case, problems with the flow of urine occur.
Benign prostatic enlargement is not dangerous in itself. However, secondary effects can occur that can cause unpleasant and dangerous problems with urination. Benign prostatic enlargement develops gradually over several years.
How do you know if you have an enlarged prostate?
These symptoms may indicate benign prostatic enlargement:
- Increased urge to urinate, especially at night (pollakiuria, nocturia)
- Difficulty starting to urinate (delayed onset of micturition)
- Weak urine stream, interrupted flow of urine
- Sudden strong urge to urinate
- Incontinence, especially at night
- Blood in the urine
- Involuntary loss of urine (urge incontinence), wetting
- Inability to urinate (urinary retention)
- Repeated cystitis up to and including kidney damage
Medication or surgery for an enlarged prostate?
A distinction is made between three stages of prostate enlargement, which require different treatments:
Stage I: Initial stage (irritation stage). Small amounts of residual urine may remain in the bladder. The bladder cannot be emptied completely. Drug treatment may be given, depending on the severity of the symptoms.
Stage II: (residual urine stage): The problems with urination now require drug treatment.
Stage III: Chronic urinary retention with residual urine of more than approx. 200 ml. In order to avoid kidney damage, a surgical procedure to remove the excess prostate tissue is required. Depending on the findings, transurethral prostatectomy (TUR-P) or holmium laser enucleation of the prostate (HoLEP) can be considered as the surgical method. As a rule, erectile function is preserved after the operation.
Which surgical methods are used at the Goldstadt Private Clinic as a specialist urological clinic?
- Transurethral resection of the prostate (TUR-P) – "scraping out" the prostate via the urethra using modern high-frequency technology (without an abdominal incision).
- Laser enucleation (e.g. HoLEP) – "shelling out" the prostate, in which enlarged tissue is precisely detached and removed with the holmium laser; particularly suitable for larger glands.
The treating urology specialist determines the appropriate surgical procedure together with the patient in a personal consultation as part of individual treatment planning, based on the size of the prostate, concomitant diseases and the treatment goal.
More information on HoLEP/TUR-P
Course of the operation
After preliminary examinations, an informative consultation and an anaesthesia consultation, the operation is performed under spinal or general anaesthesia during an inpatient stay. Fine instruments are inserted via the urethra. The excess tissue is resected or enucleated. After the operation, a bladder catheter is inserted for a short time, which is usually removed on the 2nd day after the procedure.
Advantages of surgery
- Endoscopic procedure without an abdominal incision
- Rapid and significant relief of urination problems
- No more drug treatment necessary after the operation
- Basis for stable bladder emptying in the long term
Possible risks & side effects
As with any operation, there are risks that can be kept to a minimum through good surgical planning. Bleeding, infections, temporary incontinence or sexual dysfunction may occur, for example. Serious complications are rare; all possible side effects are discussed with the patient transparently and comprehensibly in a detailed consultation before the procedure.
Questions about the diagnosis and treatment of benign prostatic enlargement
Under the influence of the male sex hormone, the prostate enlarges with increasing age. As the prostate is located at the junction of the urinary bladder and the urethra, enlargement of the prostate can lead to problems with bladder emptying by constricting the urethra.
Enlargement of the prostate leads to a narrowing of the urethra. The typical symptom of prostate enlargement is therefore a weakening of the urine stream. As the bladder wall muscle, which generates the pressure for emptying the bladder, has to overcome the increased outlet resistance of the bladder caused by the prostate, some patients with prostate enlargement also suffer from a sometimes very troublesome and sudden urge to urinate. If prostate enlargement is very pronounced or long-standing, complications such as acute urinary retention, bladder stone formation, urinary tract infections or hydronephrosis can also occur.
Starting from any problems with the prostate, prostate enlargement is diagnosed by palpating the prostate and a special ultrasound examination. In addition, determining the PSA value is recommended in order to rule out malignant enlargement of the prostate. Only in individual cases may further examinations, such as cystoscopy or X-ray examination, be useful to rule out other diseases.
Prostate-specific antigen (PSA) is a protein that is produced in the prostate and occurs naturally in the ejaculate fluid. Some of the PSA can also be detected in the blood. An increase in the PSA level in the blood can indicate the presence of a malignant tumour of the prostate.
The treatment method or a possible operation for benign prostatic enlargement depends on the patient's symptoms and the results of the urological examinations. If the symptoms are mild and bladder emptying is still good, herbal medicines can be considered. If the bladder is not emptied completely, drug treatment with a so-called alpha blocker makes sense. If the symptoms do not improve despite drug treatment or if complications of prostate enlargement occur, surgical treatment by reducing the size of the prostate or enucleating it is often recommended. This can be done, for example, by holmium laser enucleation or transurethral resection of the prostate.
Prostate enucleation and prostate resection
At the Goldstadt Private Clinic, in addition to conventional prostate resection (TUR-P), modern prostate enucleation (HoLEP – holmium laser enucleation of the prostate) is used to treat benign prostatic enlargement. These minimally invasive methods enable effective relief of symptoms and a quick recovery.
Find out more about these advanced treatment options and how you can benefit from them on the special information page on prostate resection and enucleation.
More information in the videos:
VIDEO
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What the PSA value means
An elevated PSA value causes uncertainty for many men. This video explains how the PSA value is produced, what an elevated PSA value can mean and when there is reason for further diagnostics.
- Introduction: why the PSA value is so important
- What is prostate-specific antigen (PSA)?
- Free PSA, total PSA and PSA ratio explained
- Age-adjusted normal PSA values & PSA density
- Common sources of error: examination, sport, inflammation
- Interpreting PSA fluctuations correctly
- Which PSA trends are dangerous?
- How often should the PSA value be checked?
- PSA value and age: who benefits from screening?
- Overdiagnosis vs. overtreatment – what is really true?
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Enlarged prostate
When does medication help, when to operate?
Many men with an enlarged prostate suffer from a weak urine stream, residual urine or a strong urge to urinate. The cause is often benign prostatic enlargement, medically known as benign prostatic hyperplasia (BPH). This video explains when drug therapy is sufficient and when surgery is recommended.
- Introduction: understanding prostate enlargement
- Anatomy: why does a weak urine stream develop?
- The bladder wall & urge to urinate explained
- Residual urine: recognising warning signs
- Overview of three patient groups
- Drug therapy: effect & limitations
- Surgical therapy: procedure & goal
- When is the right time for surgery?
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HoLEP
What the stay in a specialist clinic involves
Inpatient treatment for holmium laser enucleation of the prostate (HoLEP)
Holmium laser enucleation of the prostate (HoLEP) is performed for benign prostatic enlargement when symptoms such as a weak urine stream or incomplete bladder emptying are present. You can find more information on this in this video.
- Procedure: The doctor explains the procedure and risks, and the anaesthetist discusses the choice of anaesthesia (general anaesthesia or spinal anaesthesia). On the day of the operation, the patient is admitted as an inpatient having fasted.
- Operation and aftercare: Duration about one to two hours. To ensure urine drainage, a bladder catheter with continuous irrigation is inserted, which is removed after about two days.
- It is then checked whether bladder emptying is working properly again – among other things by means of a urine flow measurement and an ultrasound check.
- Duration and healing: The inpatient stay is about three days. After discharge, the internal surgical wound usually heals completely within a few weeks.
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After HoLEP surgery
How does healing progress?
Prof. Sven Lahme explains why blood or small pieces of tissue in the urine and a frequent urge to urinate can occur in the first few weeks and which physical strains you should avoid.
In this video you will learn:
- How healing progresses after HoLEP
- Why the internal wound needs time
- Which symptoms (blood or pieces of tissue in the urine, urge to urinate) are normal after the operation
- When the urological follow-up appointments should take place
- When sport, cycling and sauna are possible again
- When recovery is complete
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Weak urine stream despite a small prostate?
Prof. Sven Lahme explains why medications such as alpha blockers often do not work sufficiently for this special form of benign prostatic enlargement.
In this video you will learn:
- Why a small prostate can cause a strong urge to urinate and residual urine
- Why ultrasound alone is sometimes not enough
- When a cystoscopy makes sense
- What a middle lobe adenoma is and how it blocks the flow of urine
- When medications such as alpha blockers do not help
- When surgery (TUR-P or HoLEP) is recommended
Videos on the surgical methods:
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Prostate surgery: laser or enucleation?
In this video, Prof. Lahme explains the two different surgical methods step by step.
What you will learn in the video:
- Why surgery is performed when medication is no longer sufficient for an enlarged prostate
- How the classic TUR-P with the electric loop works and where its limits lie
- Why the laser method is an alternative with less bleeding that respects the anatomy
- Why laser surgery is recommended for a greatly enlarged prostate
- How it is possible to completely detach the prostate tissue from the capsule in HoLEP/ThuLEP
- Why the surgeon's experience is decisive for the success of the operation
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Everything you need to know about HoLEP surgery
This video shows directly in the operating theatre which devices are used in HoLEP and how the technique works.
- How does HoLEP basically work in the operating theatre?
- Which instruments are needed – laser, endoscope, morcellator?
- How is the prostate tissue detached from the capsule?
- Why is complete enucleation with a laser an advantage over conventional TUR-P?
- How does morcellation work and what is it for?
- What do the mandarin and the sausage models show?
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Holmium laser enucleation
In this video, you will learn more about holmium laser enucleation, or HoLEP for short.
- Purpose: Treatment of an enlarged prostate (benign prostatic hyperplasia) that leads to a weak urine stream, residual urine and a strong urge to urinate.
- Indication: When drug therapy is not sufficient.
- Procedure:
- Endoscopic access via the urethra
- Prostate tissue is detached from the capsule ("enucleation") – similar to peeling an orange
- The detached tissue is morcellated and aspirated (morcellator)
- Result:
- Urethra clear again, strong urine stream
- Bladder wall remains thickened → urge to urinate only improves over weeks to months
- Ejaculation reduced (dry) due to missing prostate tissue
- Erectile function usually remains unchanged
- Advantages: Minimally invasive, effective for a greatly enlarged prostate, better control than classic open enucleation.
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TUR-P versus HoLEP
Which prostate operation is the right one?
In this video, Sven Lahme compares transurethral resection of the prostate (TUR-P) with holmium laser enucleation of the prostate (HoLEP).
- How TUR-P (transurethral resection of the prostate, classic method) works
- How HoLEP (holmium laser enucleation) works
- Which of the surgical methods can be recommended?
- Guidelines vs. modern experience
- Histological examination & clarification of cancer
- Summary & clear recommendation
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Benign prostatic enlargement
Surgical methods compared
About 30% of men over 60 suffer from symptoms such as a weak urine stream, residual urine or frequent urination. In this video, Prof. Lahme clearly explains the most important treatment options for benign prostatic enlargement (benign prostatic hyperplasia, BPH) and provides orientation in the jungle of surgical methods.
- Anatomy & cause of the bladder emptying disorder
- Residual urine – when does it become dangerous?
- Explanations of surgical methods
- How do you find the right method?
- Overview of guidelines & proven procedures
- Further information
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Prostate surgery
5 methods in a fact check
Prof. Dr. Sven Lahme does the fact check: which five surgical methods have disadvantages – especially with a larger prostate – and which advantages speak in favour of modern, minimally invasive holmium laser enucleation of the prostate (HoLEP)?
In this video:
- TUR-P – classic transurethral resection of the prostate with the electric loop
- Greenlight laser vaporisation
- Partial removal of the middle lobe adenoma
- Electrical vaporisation of the prostate
- Radiological prostate embolisation
About this page:
Author
Medical director of the Goldstadt-Privatklinik.
Specialist for Urology, Mini-PCNL and robot-assisted da Vinci procedures.
Member in Scientific Societies and Reviewer of scientific journals.
