Which is The Best Methode for Prostate Surgery?

Which is Best Prostate Surgery?

One of the questions plaguing patients with benign prostatic enlargement is which surgical method is more successful.

Surgical alternatives in prostate enlargement are increasing due to both surgical experience and technological developments.

Techniques that were popular in some periods are losing their validity today, while new effective surgeries are developing. Although the excess of methods strengthens the hand of us urology physicians in treatment, it may cause confusion for patients.

What is The Fastest Way to Shrink an Enlarged Prostate?

Although each surgical method in prostate enlargement has various advantages and disadvantages compared to the other, the ideal technique may be different for each patient. While choosing this technique, the patient's factors and priorities should be reviewed and the urologist and the patient should decide together.

Some of the factors belonging to the patient;

The patient's age, comorbidities, use of anticoagulant agent, prostate volume, previous surgeries, the presence of simultaneous stones in the bladder, prostate cancer accompanying benign prostate enlargement. These factors will affect the choice of our surgical method.

Let's talk briefly about the pros and cons of the most frequently applied methods!

1- Tur-Prostatectomy Turkey (Endoscopic Prostate Surgery)

Although industrialization in the health sector seems to have put the TUR-P method in the background with the developments in laser technologies, TUR-P which is performed by plasma kinetic energy is still the standard treatment procedure for prostate enlargement in 30-80 ml volume by the European Urology Association.

Being a method that has been used for a long time, it has given many research opportunities for its postoperative results. Therefore, it is a proven procedure and it is less likely to encounter surprises for science in the coming years.

Contrary to what is thought, there is almost low possibility of having an erection problem after TUR-P. To put it more accurately, the patient's pre-operative erection capacity and post-operative capacity are nearly the same. Erection problems that develop after surgery are experienced after prostate cancer surgeries rather than prostate enlargement surgeries.

However, after TUR-P surgeries, retrograde ejaculation may occur and some orgasm problems may occur in patients. The recurrence rate of the disease in 5-year follow-ups is similar to laser enucleation methods (HOLEP). It is more advantageous than HOLEP in terms of cost. However, laser technologies are superior for bleeding control (Thulium and Holmium Laser) in patients using antiaggregant and anticoagulant drugs, which are known as blood thinners.

Again, urethral stricture, which is one of the medium and long-term complications, can be seen in approximately 5% of patients after TUR-P, and the quality of life may deteriorate with the possibility of repeated intervention.

2- Transuretral Prostate Incision (Tuip)

The biggest limiting factor for this method is that it can be applied to patients with a volume less than 30 ml and who cannot have a median (middle) lobe extending to the prostate.

However, TUIP is preferred especially in symptomatic young patients, since it does not harm ejaculation functions as well as protecting erectile functions. With this feature, it is superior to both TUR-P and HOLEP (laser enucleation methods). The short operation time and the low risk of bleeding are also advantages.

3- Laser Enuclation Prostatectomy (Holep, Thulep, Thuflep Turkey)

In this method, it is believed that the part of the prostate that blocks the urethra (urinary duct) is removed in large pieces to create a more anatomical space. In fact, although HOLEP is used as the label name because it was first made with a high-energy holmium laser, other laser energy methods work with the same logic (new generation laser systems; Thulium Fiber and Thulium Laser).

Thanks to the high energy, the prostatic adenoma tissue blocking the urinary canal is cut and removed with special tools. Thanks to this high energy, good bleeding control (coagulation) is provided. It is one of the treatment alternatives seriously recommended by the European Urology Association, especially for prostates with a volume of >80-100 ml.

Erectil dysfunction probability is lower for laser prostatectomy (especially Thulium Fiber) than the other methods. 

The rate of urethral stenosis that may develop after surgery is higher than in open prostate surgery.

These are their disadvantages. However, to reiterate, these laser methods (Thulium Laser Prostatectomy) are far superior to other methods, especially open prostatectomy, in patients using anticoagulant or antiaggregant. Short hospital stay and catheter time are also pluses.

My personal opinion when scientific data are interpreted; It is more appropriate to apply this method especially in patients with prostate volume between 100-150 ml, where adequate urethral opening cannot be achieved in TUR-P and it will be too invasive for open surgery.

4- Open Prostate Surgery Turkey

This surgery for prostate enlargement is the most invasive (with bleeding) surgery method. Skin incision, opening of the bladder are other disadvantages. It includes a longer hospital stay and recovery period compared to both tur-prostatectomy and Laser Enuclation (Holep, Thulep) surgeries.

In addition to the disadvantages listed above, there are many advantages of open prostate surgery. Since more prostate tissue can be removed in a single session and in a shorter time, studies have shown that it is the procedure in which recurrence of prostate enlargement and postoperative urethral stenosis are the least developed.

Therefore, it is the surgery with the least possibility of reoperation. It is still a frequently used method, especially for prostate tissues larger than 150-200 ml, and it is very effective. Its low cost is another advantage over other methods. In addition, the presence of large bladder stone accompanying benign prostate enlargement makes this surgery advantageous. Both prostate enlargement and bladder stone can be treated at the same time easily and without prolonging the operation time.

5- Rezum Turkey

It is a method which is vaporization of prostate tissue with thermal water. It can be applied with the help of apparatuses that are entered through the urinary canal and directed to the prostate tissue. The biggest advantage is that it can be performed even with local anesthesia in elderly patients who are very risky to receive anesthesia. In addition, it does not cause the ejaculation problem like TUR-P, HOLEP and OPEN PROSTATECTOMY.

Disadvantages are the inability to remove pathological tissue and removal of the catheter approximately 6 weeks after surgery. In addition, due to the lack of sufficient data on long-term results, it is not a proven method like TUR-P, HOLEP and OPEN PROSTATE SURGERY.

6- Green Light Laser

Vaporization with this laser method is also one of the alternative methods for bipolar TUR-P. The disadvantage of green light laser is that urologists have better experience with TUR-P, less cost of TUR-P, and the fact that scientific publications still point to TUR-P as a standard treatment method.

However, this method is also known to have an advantage over other methods. It is the safest method in patients whose anticoagulant cannot be discontinued or switched to low molecular weight heparin. Because it can make excellent bleeding control.

Latest Treatments For An Enlarged Prostate

As a result; In prostate enlargement surgery, it will be right to decide according to the conditions, especially the patient's factors and expectations. Medicine is not a science that has definite results and judgments like mathematics. What is right for one patient may be wrong for another. The interpretation of one doctor and another doctor may also differ. Medicine is therefore also an art. In addition, my personal opinion is that surgical methods that have proven themselves with more and higher quality scientific publications should always be used more.

Question-Answer

• Best Prostatectomy for patients using anticoagulant or antiaggregant; Laser prostate surgery (Thuflep, Thulep, Holep, Greenlight)
• Best Prostatectomy not detoriorated erection; Thulium Laser Prostate Surgery (Thuflep, Thulep)
• Best Endoscopic Surgery for large prostate; Laser prostate surgery (Thuflep, Thulep, Holep)
• Prostate Surgery for high risk patients; REZUM Prostate Surgery, It can be performed even with local anesthesia
• Which prostate surgery has the least side effects?; Thuflep, Thulep, Holep and REZUM
• Lower probability of urethral stenosis; Open prostatectomy
• Lower probability of prostate enlargement; Open prostatectomy
• Prostate Surgery without retrograde ejeculation; REZUM, TUIP

Prostate Surgery Cost in Turkey

The prices of surgery for prostate enlargement vary according to the prostate volume, the method used (Thuflep, HOLEP, TUR-P) and additional disease of the patient.

Urologist near me

Dr. Arif Demirbas Urology Clinic is near you for fast and effective treatment

For prostate surgery cost, Thulium laser prostate surgery cost, REZUM surgery cost: +905324850016

Whatsapp: +90 532 485 0016
Instagram: @drarifdemirbas
Youtube: @drarifdemirbas

I wish you healthy days.