Surgical Options for Men With Enlarged Prostate

Dec 2, 2013


A common rite of passage for men as they age is an enlarged prostate gland. Men over 50 years of age can typically suffer an array of bothersome urinary symptoms from an enlarged prostate, also called benign prostatic hyperplasia (BPH).

"As the prostate gets bigger, it constricts the urinary hole. As the hole gets squeezed smaller, the flow is restricted and urinary symptoms ensue," said urologist Ketan K. Badani, M.D.

Patients with an enlarged prostate may have to urinate more frequently, wake up at night to urinate, experience decreased force of stream, hesitancy, incomplete emptying, urinary tract infections and reduced kidney function depending on the severity of symptoms. The condition tends to worsen over time if left untreated. Doctors initially use medication to treat BPH. If these are ineffective, they turn to surgery.

The Techniques

In a TURP procedure, doctors shave away extra prostate tissue that is blocking urine flow, thereby increasing the urine channel and allowing patients to more easily empty their bladders. Although TURP is considered the gold standard of surgical treatment for BPH, newer versions of the procedure are becoming more popular. One variation is called laser prostatectomy, which uses a laser to evaporate the inside of the prostate. Steven A. Kaplan, M.D., also a urologist, is a big proponent of newer technologies to perform prostate surgery including the use of lasers and bipolar electrovaporization of the prostate.

"Changes are occurring in the technology and new variations of TURP that use lasers and high dose electrical energy are mitigating the side effects of older TURP procedures including bleeding, possible blood transfusions and incontinence. We are examining new technologies such as a new higher power green light laser that can remove more tissue in a shorter amount of time," said Dr. Kaplan. To date, he has performed about 3,500 TURP procedures or variations of the procedure in his career. "Most of my prostate surgery procedures take less than an hour, allowing patients to go home the same or next day," he added.

Robotic prostate surgery is also being performed at NYP in cases with extremely enlarged prostate glands. "If a patient has a massively enlarged prostate (>80 g) then TURP or laser prostate surgery may not be an option," said Dr. Badani.

Traditionally, a simple prostatectomy is performed with an incision from the belly button to the pubic bone. But Dr. Badani prefers robotic surgery which requires only small incisions to be made in the abdomen. He recently performed robotic surgery on a patient with a prostate that had enlarged to 778 g (the average size of an enlarged prostate is 30 g). Dr. Badani and colleagues are publishing a case report on the procedure. In fact, it looks like his team has also made it into the records books as Guinness Book of World Records currently lists the largest prostate removed at 650 g. "We have the expertise to be able to perform robotic prostate surgery. There are not many institutions with a lot of experience in this area," added Dr. Badani.

"Surgical outcomes seem to be better with a lot of experience. Because NYP is very specialty-oriented, we are more likely to have excellent results and improved outcomes whether it be laser prostate surgery I am working on or Dr. Badani's robotic surgery. We are refining our procedures and getting better and better," said Dr. Kaplan.