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Prostate Cancer

Benign Prostate Enlargement (BPE/BPH)

BPE, also known as BPH, occurs in most men with aging. The prostate gradually increases in size and pinches the urethra. This can cause a variety of urinary problems including frequent daytime and nighttime voiding, urgent voiding, slow urine flow, sensation of poor bladder emptying, urinary infections, or bleeding. This medical condition can be treated by our urology team.

Laser Prostatectomy/Photoselective Vaporization of the Prostate (PVP)


Electrosurgical Transurethral Resection of Prostate (TURP)

What is Photoselective Vaporization of the Prostate?

This is a procedure that attempts to alleviate urinary symptoms caused by benign enlargement of the prostate gland. The enlarged prostate can compress the urethra and cause bothersome urinary symptoms. The procedure removes prostate tissue by using a laser. Less prostate allows easier urinary flow. Similar techniques such as Transuretheral Resection of the Prostate (also commonly know as TURP) have been successfully used to treat urinary problems caused by the prostate for several decades. The TURP procedure does result in patients having to stay in the hospital for a day or two as there can be more bleeding and other complications. The use of the laser has allowed us to operate with less concern for bleeding allowing for outpatient surgery in most cases.

Who benefits from Photoselective Vaporization of the Prostate?

Patents with urinary obstruction caused by benign enlargement of the prostate gland will benefit the most. Common symptoms of this condition are slow urinary stream, dribbling, frequent or urgent urination, and rising frequently to urinate during the night. This procedure may not work well for very large prostates and other options might be better (e.g. TURP, open simple prostatectomy).

What is our experience with robotic surgery?

There is an almost immediate improvement in the urinary stream. This will allow for shorter and more efficient trips to the rest room. Frequent or nighttime voiding and urgent urination tend to take longer periods of time to improve. The goal of the procedure is to control urinary symptoms adequately without requiring the use of additional medications. Medications used for prostate enlargement are typically stopped between four and six weeks after the surgery.

What is the expected postoperative course?

The surgery typically last between one and three hours. The patient will wake up with a rubber tube called a catheter that drains the bladder. These catheters typically remain in overnight and can be safely removed at home in most circumstances. Patients are able to leave the hospital within two to three hours after the surgery. Once at home I encourage light activity for a three-week period of time. Pain is relatively minimal and short-lived, however patients are sent home with pain medications. There is some discomfort or burning in the penis that can last on and off for up to several weeks. This is related to the prostate gland healing from the surgery. Some patients do report discomfort at the tip of the penis that is mild and short lived. Patient can see blood in the urine on and off for several weeks following the procedure. This is usually related to physical activity, which is one of the main reasons why we encourage only gentle exercises such as walking for the first three weeks following the procedure.

What are the complications of this Procedure?

Uretheral discomfort as mentioned above. Bleeding as mentioned above. An infection of the bladder or kidney is a possibility but is unlikely, urinary leakage (otherwise called incontinence) is a rare but serious complication. One in twenty men will have problems obtaining a normal penile erection after the surgery. A very common complication after the surgery is a dry ejaculate. This is due to the change in the opening between the bladder and the prostate caused by the procedure. A narrowing in the urethra called a stricture is a complication that can result in other minor procedures. Additionally, areas of the prostate may continue to grow and cause future obstruction after the procedure.

What are the disadvantages of Photoselective Vaporization of the Prostate?

The main disadvantage is that as the tissue is turned into gas, no tissue is available for analysis. In rare cases this could potentially miss a prostate cancer that may exist in the prostate gland. In order to help ensure that prostate cancer is not present at the time of the procedure, blood test are usually checked to screen for patents that may potentially have cancer and a prostate biopsy would be performed if there is a suspicion. These procedures are less durable than other alternatives (like TURP).

What are the alternatives to Photoselective Vaporization of the Prostate?

There are medical treatments that are available to treat this condition. Other surgical alternatives are Transuretheral Resection of the Prostate or TURP. In rare cases of an exceptionally large prostate gland, patients may benefit from a major surgical procedure to remove larger volumes of prostate tissue. Should you have any questions about these please consult your physician.

What is TURP?

This procedure is done with either a general or spinal anesthetic. A telescope is passed through the penis into the bladder. A small electrical cutting device is used to cut the prostate into pieces. The pieces are removed through the telescope and examined under a microscope. The surgery lasts for 1 to 2 hours. A rubber tube called a catheter is left in the bladder. Patients stay in the hospital overnight in most cases. The catheter is usually removed before leaving the hospital.

What can I hope to improve by the surgery?

There is an almost immediate improvement in the urinary stream. This will allow for shorter and more efficient trips to the rest room. Frequent or nighttime voiding and urgent urination tend to take longer periods of time to improve. The goal of the procedure is to control urinary symptoms adequately without requiring the use of additional medications. Medications used for prostate enlargement are typically stopped between four and six weeks after the surgery.

What are the complications of TURP?

A blood clot in the bladder is the most common complication. The blood clot can make it hard to go to the bathroom. This can be troublesome for 1 out of 10 men that have the procedure and is a short-term problem. An infection of the bladder or kidney is a possibility but is unlikely, urinary leakage (otherwise called incontinence) is a rare but serious complication. One in twenty men will have problems obtaining a normal penile erection after the surgery. A very common complication after the surgery is a dry ejaculate. This is due to the change in the opening between the bladder and the prostate caused by the procedure. A narrowing in the urethra called a stricture is a complication that can result in other minor procedures. Additionally, areas of the prostate may continue to grow and cause future obstruction after the procedure.

What are the advantages of TURP?

This operation is more effective than the laser procedures at removing large amounts of prostate tissue and the good urinary effects last longer. Patients with very large prostates might get more benefit from this procedure than laser procedures.


​Medical Management of BPH

Not every patient needs surgery to manage their urinary problems. Our facility has cutting edge technology for the medical management of prostate enlargement.