Endoscopic surgery of benign prostatic hyperplasia (BPH)

Introduction

The prostate is an organ of the male, located below the bladder lying on the pelvic floor. The urethra takes its course from the bladder neck through the prostate, the outer sphincter and finally as penile urethra through the penis. During the course of life, changes in the hormone balance lead to an increase in prostate size.

On the one hand, the prostate can grow outward, thus increasing measurable volume; On the other hand, there is a possibility the prostate is growing inwards. If this happens, the free diameter of the prostatic urethra is consequently narrowed (prostate with benign prostatic hyperplasia (BPH)). The bladder muscle must work against increased resistance.

Symptoms

As a result, different symptoms can occur: Examples include an attenuated urinary stream and thus a prolonged void, the delayed voiding and the so-called two-time void. After the initial urine a few moments have to pass, until the micturition can be restarted.

Prostatavergrößerung - Gesunde Prostatat | Prostata mit BPH
Prostate enlargement: Healthy prostate | Prostate with BPH

It can also lead to residual volume, diverticulum or bladderstones. It also can occur a complete urinary retention, which makes a catheter supply through the urethra necessary.

The symptoms can be very debilitating and are initially treated with medication. If this is not successful or the symptoms get worse, an operation is the next step. The indication for surgery will be provided after careful examination in accordance with the German and European guidelines and a personal discussion with you.

The operation

The principle of any surgery to eliminate the symptomatic enlargement of the prostate gland is the removal of the prostate adenoma that narrows the prostatic urethra. The prostate consists of the narrowing adenoma tissue and a capsule that surrounds the adenoma like an orange peel.

Procedures

One differentiates the open operation through the abdominal wall and the transurethral operations through the urethra. In open surgery, the so-called simple prostatectomy, the prostate adenoma is removed by abdominal incision. This procedure is usually performed in prostates greater than 100 ml. The indication also depends on the preference of the urological department. This method is invasive and looses its importance due to the increasing prevalence of HoLEP (Holmium Laser Enucleation of the Prostate).

Surgery through the urethra can be classified as melting down and tissue-ablative procedures. In the melting process, the tissue is „melted down“ by heat energy (eg „Green Light Laser“). These methods are usually the gentlest but mostly only after a delay effective.

The classical prostate operation through the urethra, means peeling the adenoma with an electric loop through the urethra (transurethral resection of the prostate (TURP)). This procedure produces prostate „chips“ which are then rinsed out of the bladder via the urethra.

Laser systems

In the course of time, processes with different laser systems have been developed in particular, which make it possible to „enucleate“ the prostate through the urethra. The prostate adenoma is peeled like an orange out of its capsule. One speaks of enucleation. The procedure we offer is the Holmium Laser Enucleation of the Prostate (HoLEP).