Benign prostate hyperplasia, or BPH, is one of the most common health problems in older men. About half of all men ages 51 to 60 have BPH, and that percentage goes up with age.
“As the hair turns gray, the prostate gets bigger,” says Dr. Ahmed Mansour, assistant professor of urology at UT Health San Antonio who practices at University Health System.
As it enlarges, the walnut-sized prostate squeezes the urethra, leading to problems with urination.
Patients are first advised to try lifestyle changes, followed by medication, to reduce the symptoms of BPH. After that, surgical techniques to remove the excess tissue blocking the urethra are the next line of treatment. Side effects, however, can include bleeding, incontinence, sexual dysfunction and the need for repeat surgery.
But there are promising alternatives.
Holmium laser enucleation of the prostate, or HoLEP — and more recently, thulium laser enuclation of the prostate (ThuLEP) — have emerged with the advantages of shorter hospital stays and lowered risk of bleeding and other side effects.
University Health System has joined a small number of centers around the country offering ThuLEP. The procedure involves threading a narrow catheter containing the laser and camera through the penis and urethra into the prostate. The surgeon uses the laser to separate the gland tissue from the outer capsule, or outside portion of the prostate. “Like peeling an orange,” as Dr. Mansour describes it.
Unlike transurethral resection of the prostate, or TURP, the “gold standard” for surgical treatment of BPH, excess tissue isn’t cut away in pieces but rather separated whole and pushed into the bladder, where a second instrument grinds and suctions the gland tissue away.
The new procedure also allows surgeons to treat patients with very large prostates, which can occur with medical treatment over time. The risk of bleeding is minimized, as is the risk of incontinence and sexual problems due to incidental nerve damage.
After a 23-hour observation stay in the hospital, the catheter is removed and the patient goes home. Relief of symptoms is immediate.
The ThuLEP procedure is also considered for some men with enlarged prostates and prostate cancer undergoing a “watchful waiting” line of management. The procedure can offer relief of symptoms, with a secondary effect of making the PSA test more sensitive.