Benign prostatic hyperplasia (BPH) is a common condition, particularly in men over the age of 50. The growth of prostate tissue puts pressure on the urethra, causing symptoms such as frequent urination, straining, and incomplete bladder emptying.
Prostate surgery is often considered for patients who do not respond to medical treatment or who experience severe urinary obstruction. Advancing technology has led to the emergence of many different surgical methods.
Factors Affecting the Choice of Surgical Method
The surgical method chosen depends entirely on the patient's individual characteristics. These factors include:
The patient's age and general health status
Use of blood-thinning medications
Prostate volume
Previous surgeries
Presence of bladder stones
Presence of associated prostate cancer
These variables directly influence the surgical technique chosen by the urologist.
1. TUR-Prostatectomy (Closed Prostate Surgery)
TUR-P is a procedure that has been used for many years and is currently accepted by the European Association of Urology as the standard treatment for prostate enlargements between 30 and 80 ml in volume.
It is inserted through the tip of the penis using a camera and an optical system, and the obstructing prostate tissue is removed using plasma kinetic energy.
The advantage of this method is that it is a classic and scientifically proven treatment.
Erectile dysfunction is generally not experienced after the surgery. However, retrograde ejaculation (regurgitation of semen) may occur in some patients.
The 5-year follow-up results of TUR-P show similar success rates to laser enucleation (HOLEP).
It is more cost-effective, but laser methods are safer in patients taking blood thinners due to the risk of bleeding.
In the long term, urethral stricture can develop in approximately 5% of cases.
2. Transurethral Prostatic Incision (TUIP)
TUIP is used in patients with a prostate volume smaller than 30 ml. In this method, prostate tissue is not removed; only small incisions are made to relieve the urethra.
The greatest advantage of TUIP is that it preserves erectile and ejaculatory functions.
Therefore, it is particularly preferred in young and sexually active men.
Furthermore, the surgery time is short, the risk of bleeding is low, and the recovery period is quite comfortable.
However, this method is not sufficient for patients with large prostate volumes.
3. Laser Enucleation Prostatectomy (HOLEP, THULEP, THUFLEP)
Laser prostate surgery, which has become popular in recent years, uses high energy to remove large portions of the obstructing prostate.
This method is recommended by the European Association of Urology, especially for prostates larger than 80–100 ml.
Thanks to laser energy, bleeding control is excellent, which is a major advantage for patients taking blood-thinning medications.
Additionally, the catheterization period is short (an average of 2 days), recovery is rapid, and the hospital stay is short.
The THUFLEP technique limits tissue damage to only 0.2 mm; This provides a significant advantage in maintaining erections.
However, the rate of urethral stricture may be slightly higher than with open surgery.
As a personal recommendation, laser enucleation surgery is both a safe and effective option for prostate volumes between 100–200 ml.
4. Open Prostate Surgery
Open prostate surgery, the most classic and most invasive method, is used especially in patients with very large prostate volumes (over 150–200 ml).
The skin and bladder are opened and the prostate tissue is removed.
This method carries a higher risk of bleeding and the need for blood transfusions than other techniques.
However, its advantages should not be overlooked:
A much larger amount of prostate tissue can be removed in a single session.
The long-term recurrence rate is low.
It is the method with the lowest risk of urethral stricture.
It is the most cost-effective option.
Furthermore, if there are bladder stones, they can be easily removed during the same surgery. This offers an effective and comprehensive solution.
5. Rezum (Prostate Treatment with Water Vapor)
The Rezum method is based on the principle of vaporizing prostate tissue using thermal water vapor.
It can be performed under local anesthesia via the urethra.
This method is a suitable alternative for elderly patients with a high risk of anesthesia.
It also does not cause ejaculation problems.
However, its disadvantages include the inability to collect tissue for pathological examination, the prolonged catheterization period (approximately 6 weeks), and the lack of clear long-term results.
Rezum is an innovative and minimally invasive method still in the research phase.
Conclusion: Which Prostate Surgery is Most Appropriate?
Each patient's prostate structure, age, general health, and expectations are different.
Therefore, personalized surgical planning, rather than a "one-size-fits-all" approach, is the best approach.
TUR-P: A standard and economical method for medium-sized prostates.
TUIP: A sexual function-preserving option for young patients.
HOLEP / THULEP / THUFLEP: Modern, safe, and rapid laser methods for large prostates.
Open Prostatectomy: A permanent solution for very large prostates.
Rezum: A minimally invasive option for elderly patients with high anesthesia risk.
Conclusion