Benign enlargement of the prostate (benign prostatic hyperplasia; BPH) is a so-called widespread disease. This means that it occurs very frequently and around a quarter of all men over the age of 60 suffer from it. Enlargement of the prostate is not a disease in itself. The causes of prostate enlargement are not fully understood. BPH can become a disease if it causes symptoms. These can be characterised by problems urinating (so-called LUTS symptoms: Weakening of the urinary stream, prolonged urination, delay in starting to urinate, dribbling etc.), blood in the urine (haematuria) or recurrent urinary tract infections. This is referred to as benign prostate syndrome (BPS).
In order to assess and evaluate the severity of BPH, the severity of a number of symptoms is considered (e.g. International Prostate Symptom Score; IPSS) and objective parameters, e.g. urinary flow rate (uroflow) and prostate size are measured using transrectal ultrasound and the prostate is assessed by palpation. Analysing various factors provides a good overview of the extent of the disease and the treatment options.
We offer you state-of-the-art medicine combined with personalised care:
- Detailed consultation and individual treatment planning in close collaboration with our cooperation partners (urologists in private practice, physiotherapy) in the pre-operative planning and post-operative phase of the operation.
- Comprehensive diagnostics with high-resolution imaging procedures (TRUS, multiparametric MRI)
- Various endoscopic treatment procedures for medium-sized to very large prostate glands using monopolar and bipolar video resection techniques(TURP) and holmium or thulium laser enucleation(HoLEP, ThuLEP).
- Gentle, minimally invasive water vapour ablation of the prostate(Rezüm therapy)
- Surgical enucleation techniques for very large prostate glands > 200 cm3.
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In most cases, therapy begins with the intake of typical prostate medication (alpha blockers, 5-alpha reductase inhibitors) and medication to alleviate the irritation symptoms. The use of phytotherapeutics can also be useful and can be taken in addition. Depending on the severity of the symptoms, the size of the prostate and the accompanying circumstances, drug therapy is carried out in accordance with the guidelines after a detailed consultation with your urologist or, if desired, in our consultation hours. Nowadays, combinations of medication are often used to prevent the progression of the disease and the worsening of symptoms. Regular check-ups, including ultrasound, are necessary to monitor success.
If BPH worsens, surgery is the treatment of choice in most cases. There is a wide range of different procedures available, which must be tailored precisely to the symptoms and size of the prostate. You can be advised about these procedures in a preliminary consultation:
Transurethral incision of the prostate (TUIP)
This involves an endoscopic incision of the prostate at two different points down to the prostate capsule. The result is an improvement in the flow of urine. As no tissue is removed during this procedure, a possible renewed worsening of the symptoms is to be expected.
Water vapour ablation of the prostate (Rezüm therapy)
Rezüm therapy involves treating the excess prostate tissue by applying water vapour. This procedure is carried out endoscopically via the urethra and can also be performed under local anaesthetic if the patient wishes. Depending on the size of the prostate, it may be necessary to leave a urinary catheter in place for a longer period of time after the procedure.
Transurethral resection of the prostate (TURP)
In this procedure, tissue from the enlarged part of the prostate gland, the so-called adenoma, is removed endoscopically through the urethra using an electric snare under visualisation. The removed tissue is flushed into the urinary bladder during the operation and the resection chips are removed from the bladder at the end of the operation. High-resolution HD monitor technology provides a good view of the surgical field and the tissue can be removed in a very targeted manner.
Transurethral enucleation techniques (HoLEP, ThuLEP)
The anatomy of the prostate is respected more during the removal process. The aim is to remove exactly the enlarged part of the gland (adenoma) while preserving the prostate capsule. Enucleation techniques can be performed using many different instruments. We use the holmium laser (HoLEP), the thulium laser (ThuLEP) and bipolar resection using a special snare (EEP) for transurethral enucleation of the prostate. From a certain prostate size, transurethral enucleation techniques are still technically feasible, but not necessarily always sensible. In these cases, we may recommend performing a prostate adenoma enucleation via the abdominal wall. Which procedure is the most suitable in your case can only be clarified in a consultation with your doctor.
The urethral sphincter muscle is spared during BPH surgery. Very rarely, however, continence may be impaired due to the anatomical proximity of the prostate to the sphincter muscle. Since in many cases there is already a long history of increasing BPH symptoms, the application of energy after the operation can lead to temporary irritation symptoms, particularly frequent urination and sudden urge to urinate. Occasionally, sphincter weakness before the operation can be "masked" by an enlarged prostate. Temporary stress urinary incontinence may then occur after the operation. In many cases, this can be treated with physiotherapy. Loss of potency after endoscopic prostate surgery is extremely rare. However, ejaculation is restricted or lost in many cases as a result of the operation. Whether an "ejaculation-sparing" surgical procedure is still possible can be discussed with you in a preliminary consultation.
Almost all prostate operations require the insertion of a bladder catheter for several days after the operation. In most cases, this is a special catheter to flush the bladder and prostate wound area. After the urine has cleared up, usually after 1-3 days, the catheter is removed. If the urine is still bloody in colour, it may be necessary to leave the catheter in place for longer. This must always be decided on an individual basis by your doctor.