Benign prostatic hyperplasia (BPH) is one of the most common disorders affecting men as they grow older. Men face the decision of whether to hassle with the side effects of an enlarged prostate or undergo surgery to eliminate the condition and possible serious complications.
Understanding the Prostate
The prostate is a walnut-sized gland located between the bladder and the penis, just in front of the rectum. It is part of the male reproductive system and has the job of producing the fluid that mixes with sperm to form semen during ejaculation. The prostate also surrounds the urethra, which is the tube that urine flows through from the bladder to the penis.
Most men don’t give their prostate a second thought until around midlife, when it may begin to grow and become enlarged, which is known as BPH. This disorder affects 50 percent of men in their 50s, and by the time men reach their 70s, 80s, or older, as many as 90 percent can be affected by BPH.
When the prostate swells it presses on the urethra, blocking urine flow. When this happens, a man will experience certain symptoms that get his attention. One of the more common symptoms is the need to urinate often, sometimes as frequently as every one to two hours, especially at night.
Other symptoms can include the following:
- Feeling that the bladder is full even right after urinating
- Urgency to urinate
- Weak urine flow
- Dribbling of urine
- The need to stop and start urinating several times
- Trouble starting to urinate
- The need to push or strain to urinate
Many men assume that BPH is an inevitable part of aging and that they must live with the symptoms. This thinking is a mistake because even though BPH is not cancer, if left untreated, it has the potential to lead to issues such as urinary tract infections, bladder or kidney stones, blood in the urine, or kidney damage.
So men need to decide if they want a medical intervention or if they want to deal with the symptoms and take the chance, knowing that BPH may cause a more serious condition.
If they want treatment, there are many effective options from which to choose. Two of the less invasive prostate surgeries are button TURP and green light laser.
Bipolar cautery vaporization, or button TURP, is a newer, less invasive variation of what has traditionally been the mainstay for treating BPH—a procedure known simply as TURP.
TURP is where the surgeon inserts a well-lighted scope into the urethra using a wire loop or laser to cut and remove excess prostate tissue one piece at a time. The older version had increased risks of bleeding, incontinence, and impotence, as well as requiring a one- to five-day hospital stay and significant restrictions on activity for a six-week postoperative period.
The newer, improved version, button TURP, does not use a wire loop or laser but instead uses a small, button-shaped device to vaporize the prostate tissue. It also uses low-temperature plasma energy, instead of heat, to remove prostate tissue. Once the extra tissue is removed under anesthesia, the area around it is sealed off to prevent bleeding.
Button TURP is just as effective as traditional TURP at shrinking the prostate but with fewer complications, like bleeding after surgery. It can also shorten the time a man has to use a catheter (a tube to remove urine) after surgery.
Button TURP also has the advantage of preventing a rare but very serious complication called TUR syndrome. With traditional TURP, the surgical area is washed with a solution to keep the area clean, but because the solution is low in sodium, if it gets into the bloodstream, it can lower sodium levels in the body. Button TURP uses a saltwater or saline solution, which prevents TUR syndrome.
This allows the surgeon to spend more time doing the procedure, meaning they can work on larger prostates or perform more complex surgeries.
Green Light Laser
Laser prostate surgery, also known as green light laser, is a treatment that uses high-powered laser energy to remove enlarged prostate tissue by vaporizing the tissue. The aim is to leave a wide channel to restore normal urinary function.
Under anesthesia, a small, flexible fiber-optic device is inserted into the urethra and pulses of light are sent through the fiber to cut away the prostate tissue obstructing urinary flow.
The procedure takes 60 to 90 minutes and the patient will be allowed to return home on the same day or, if required, may have to spend overnight. There is minimal bleeding or pain after the procedure.
For two weeks, a patient should avoid strenuous activity but should be able to return to work within five days after surgery.
How They Compare
Both button TURP and green light laser have similar advantages: both are either an outpatient or overnight procedure and both have a decreased chance of bleeding, a faster return to activities, and a reduced time period of catheterization.
For most patients, the procedures do not interfere with sexual function, and men should still be able to achieve an erection and orgasm as they did preoperatively.
An advantage button TURP has over green light laser is that the surgeon is able to retrieve a sample of the prostate tissue, which can be examined for any signs of prostate cancer. In addition, the button TURP procedure takes less time (about 60 minutes) to remove tissue. Many men also experience fewer post-surgery symptoms with button TURP compared to laser surgery.
Ultimately, the decision of which one to use should be guided by an experienced urologist who has performed numerous surgeries using both button TURP and green light laser. The doctor can help a man to determine the course of action to achieve the best results.
Dr. David Samadi is the chairman of the urology department and chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel’s Medical A-Team. Learn more at RoboticOncology.com and visit Dr. Samadi’s blog, SamadiMD.com