Minimally Invasive Surgery For BPH 2

Minimally Invasive Surgery For BPH 2


  • Laser - HOLEP / HOLAP
  • TURP - Bipolar / Conventional


  • Prostate is a small gland wrapped around the urethra
  • between bladder and urethral sphincter
  • Enlarged prostate may compress the urethra making it difficult to empty bladder
  • Examination and investigation will reveal that the urinating difficulty is due to obstruction by
  • prostate
  • After discussion, you and your urologist may decided that prostate surgery is the best option
  • for you

Minimally Invasive Surgery

  • Involves endoscopic removal of prostate with a special instrument placed through the penis resulting improvement in the flow of urine

Options Available

  • Laser surgery 
  •  TURP
  • Bipolar
  • Conventional

1) Holmium laser surgery

  • HOLAP (Holmium Laser Ablation of the Prostate)
  • Is vapourisation of inner prostate tissue using Holmium laser
  • HOLEP (Holium Laser Enucleation of the prostate)
  • It is enmass removal of the inner prostate tissue using holmium laser with a special
  • instrument placed through the penis.
  • Advantages of laser surger
  • Minimal bleeding during surgery
  • Shorter hospital stay (1-2 days)
  • Anti coagulant drugs need not be stopped (asprin / clopidogrel)
  • Usally recommended in
  • Elderly patient
  • Cardiac patients with stents
  • Patient on blood thinning agents (asprin / clopidogrel)
  • renal failure patient

2) TURP (Transurethral Resection of Prostate)

  • Is coring out the inner prostate with a special instrument placed through the penis
  • Is a new technology which prevents most of the complications of convention TURP

Before Surgery

  • You will be asked to admit in the hospital on the day of surgery and follow the given instructions
  • An anesthesiologist will meet you pre-operatively to discuss the best way to keep you comfortable during surgery
  • You will be asked not to eat or drink anything for a number of hours before surgery
  • Bleeding risk is increased in persons on blood thinning agents like aspirin/clopidogrel
  • Please give these details to the doctor, if any, these drugs are normally stopped prior to surgery


Is performed either through

  • Spinal anaesthesia - below waist anaesthesia by inserting a needle in the back
  • General anaesthesia - putting you to sleep
  • Operation is carried out with a special instrument - Laser Cystoscope / resectoscope
  • passing through the penis. No skin inscision is required
  • The obstruction part of prostate is removed / vapourised (thus allowing the urine to
  • flow more freely, the bladder to empty more completely
  • A catheter tube is passed through your penis into bladder at the end of operation
  • A water solution is used to wash out any blood from the bladder
  • The prostate tissue removed is sent for HPE (Biopsy)

After surgery

  • You will kept in recovery room for couple of hours until it is safe to return to your room
  • You will be allowed to eat/drink 3-4 hours after surgery
  • The catheter is usually removed in 1-2 day, once the drainage is clear
  • Catheter tube in bladder may cause mild discomfort which can be controlled with medication
  • You will be discharged 1-3 days after surgery once you urinate satisfactorily. Some men are sent home with catheter which will be removed on OPD basis in a few days
  • After catheter removal, you may have difficulty in controlling your urination, have urgency, while passing urine. These discomforts improve in few weeks

Discharge Advice

  • At home , you should
  • Avoid lifting heavy object
  • Avoid strenuous physical activity for 4 weeks
  • Avoid becoming constipated
  • Increase the fluid intake (200ml every 2 hours)
  • At times, small amount of blood / clots may be passed in urine for upto 3 weeks, in such cases increase fluid intake
  • Significant improvement in your urine flow is seen after 4-6 weeks of surgery

Complications of surgery

  • Small risk of bleeding / infection - requiring antibiotic treatment or sometimes blood transfusion
  • Retrograde ejaculation - backward flow of semen into bladder on ejaculation. No treatment required as this will not affect your sexual activity
  • Few men may continue to have poor urine flow despite surgery if the bladder is decompensated (poorly functioning bladder)
  • In some men, prostate may regrow in few years requiring further investigation and treatment

Follow -up

  • To visit the urologist 1 week after surgery
  • Biopsy (HPE), report may reveal unexpected prostate cancer resulting in further investigation / treatment




MBBS, MS (Gen Surgery), M.Ch(Urology)
Consultant Urologist, Andrologist & Kidney Transplant Surgeon


MBBS, MS, Mch (Urology)
Consultant Urologist


Guest Speak

Awesome. Explained about the pain, root causes and solutions very clearly. Thanks to Dr. S. Sundar :)