Dr. Samadi explains: How best to treat an enlarged prostate?

Understanding the prostate

The prostate is a walnut-sized gland located between the bladder and the penis lying just in front of the rectum. It is part of the male reproductive system and has the job of producing the fluid mixing with sperm to form semen during ejaculation. The prostate surrounds the urethra, the tube that urine flows from the bladder through the penis.

For most men, their prostate usually doesn’t give them a second thought until around mid-life when it begins to grow becoming enlarged and then is known as BPH. BPH affects 50% of men in their 50s and by the time a man reaches his 70s, 80s or older, as many as 90% of males can be affected by BPH.

For most men, their prostate usually doesn’t give them a second thought until around mid-life

A result of the prostate swelling is it will press 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:

• 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

If left untreated, BPH can lead to urinary tract infections, bladder or kidney stones, blood in the urine or kidney damage

Many men assume that BPH is simply an inevitable part of aging and that they must live with the symptoms. This thinking is a mistake as even though BPH is not cancer, if left untreated, it has the potential of leading to issues of urinary tract infections, bladder or kidney stones, blood in the urine or kidney damage.

This is when a man will need to decide if he wants to return to a better quality of life or deal with the symptoms and take the chance of BPH leading to more serious medical complications.

There are many effective treatment options from which to choose with two being less invasive prostate surgeries – Button TURP and Green-Light Laser.

Button TURP

Bipolar cautery vaporization, or button TURP, is a newer, less-invasive variation of what has traditionally been the mainstay for treating BPH – 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. This older version had increased risks of bleeding, incontinence, and impotence as well as 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. It is still just as effective as traditional TURP at shrinking the prostate but with fewer complications, such as bleeding after surgery, and can shorten the time a man has to use a catheter (a tube to remove urine) after surgery.

Button TURP also has an advantage post-surgery of preventing a rare but very serious complication called TUR syndrome. With traditional TURP, the surgical area is washed with a solution keeping 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 using high-powered laser energy to remove enlarged prostate tissue by vaporizing the tissue with the aim of leaving a wide channel to restore normal urinary function. Under anesthesia, a small flexible fiber-optic is inserted into the urethra while pulses of light are sent through the fiber cutting 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 is to avoid strenuous activity but should be able to return to work within five days after surgery.

Analysis of both procedures

Both button TURP and green-light laser have similar advantages: both are either an outpatient or overnight procedure, both have less chance of bleeding, there’s a faster return to activities, and 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.

Laser prostate surgery – also known as green-light laser – is a treatment using high-powered laser energy to remove enlarged tissue

An advantage button TURP has over green-light laser is that the surgeon is able to retrieve a sample of the prostate tissue to be examined for any signs of prostate cancer. In addition, it takes a shorter period of time, about 60 minutes, to remove more tissue with button TURP over green-light laser. Many men will also experience fewer post-surgery symptoms when button TURP is performed over 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. They can help a man to determine the course of action to take to achieve the best results.

Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital. He is a medical correspondent for the Fox News Channel's Medical A-Team. Follow Dr. Samadi on Twitter, Instagram, Pinterest, SamadiMD.com and Facebook.