Treatment Options for Prostate Enlargement (BPH) - TURP/ HOLEP (Laser Prostate Surgery)

1. Medications for Prostate Enlargement

How We Do It

Medication is usually the first line of treatment for mild to moderate symptoms.
Your urologist evaluates your prostate size, urine flow test, PSA level, and kidney function before starting medicines.

The two main groups of medicines are:

• Alpha-blockers – relax prostate and bladder neck muscles to improve urine flow.

• 5-alpha reductase inhibitors – can shrink the prostate over 3–6 months.

• Anti-Cholinergics - Can relax bladder muscles and reduce overactive symptoms. (Used with caution in case of high urinary residue)

• B3-agonist - Novel agents, can provide similar actions like anti-cholinergics with much lesser side effects.

Pre-Requisites

• Medications can be started for all prostate sizes

• No severe urinary obstruction (May require catheter insertion and early surgical plan)

• Normal kidney function (Poor kidney function may warrant further investigations)

• No other medical contra-indications.

Expected Recovery

• Symptom relief begins within 7–14 days for alpha-blockers.

• Prostate shrinkage may take 3–6 months.

• Some patients may need combination therapy for better results.

2. Minimally Invasive Laser Treatment – HOLEP (Holmium Laser Enucleation of Prostate)

How We Do It

• HOLEP is performed through the urine passage without any cut.

• A high-powered holmium laser is used to enucleate (remove) the enlarged prostate tissue completely.

• The tissue is then removed using a morcellator.

• No external scars, minimal bleeding, and long-term removal of obstruction.

Pre-Requisites

• Suitable for all prostate sizes, small to very large (up to 100 g).

• Patients on blood thinners can also undergo HOLEP in most cases.

• Need preoperative evaluation:

  • PSA and other blood investigations like Complete blood counts and Kidney function test

  • Urine culture

  • Kidney and bladder ultrasound

  • Uroflowmetry with post void residue

  • Cardiac fitness (for anaesthesia)

Expected Recovery

• Catheter removed within 24-48 hours in most patients.

• Discharge next day in most cases.

• Resume routine work in 3–5 days.

• Complete recovery of urinary flow within 1–2 weeks.

• Long-term results are excellent

• Heavy physical activities like running, jumping, jogging, Gym avoided for at least 4 weeks

3. TURP (Transurethral Resection of Prostate)

How We Do It

• Procedure is done through the urethra without any incision.

• An electrical loop is used to cut and remove obstructing prostate chips.

• Tissue is removed gradually until the blockage is cleared.

Pre-Requisites

• Best for prostates up to 60–80 grams.

• Normal sodium levels and kidney function should be ensured before surgery.

• Need preoperative evaluation:

  • PSA and other blood investigations like Complete blood counts and Kidney function test

  • Urine culture

  • Kidney and bladder ultrasound

  • Uroflowmetry with post void residue

  • Cardiac fitness (for anaesthesia)

Expected Recovery

• Catheter stays for 1–2 days.

• Hospital stay of 1–2 days.

• Return to work in 5–7 days.

• Some burning or frequency may persist for 1–2 weeks as healing occurs.

• Long-term results are excellent

• Heavy physical activities like running, jumping, jogging, Gym avoided for at least 4 weeks