science

Surgery for benign prostatic hyperplasia

Surgery for benign prostatic hyperplasia is a science topic covered in the lgStudy science library. This page brings together a partial reference excerpt, illustrations, worked examples, real-world applications and a short study plan, so you can understand Surgery for benign prostatic hyperplasia rather than just read about it. In short: If medical treatment is not effective, surgery may need to be performed for benign prostatic hyperplasia. Invasive therapies There are two invasive surgical procedures done for BPH: Transurethral resection of the prostate (TURP): In general prior to emergence of laser technologies, TURP had been considered the gold standard of prostate interventions for people who require a procedure.

Key takeaways

Surgery for benign prostatic hyperplasia belongs to science; place it in that map before memorising details.
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Reproduce the core statement of Surgery for benign prostatic hyperplasia from memory before moving on to harder problems.

Reference excerpt

If medical treatment is not effective, surgery may need to be performed for benign prostatic hyperplasia.

Invasive therapies There are two invasive surgical procedures done for BPH:

Transurethral resection of the prostate (TURP): In general prior to emergence of laser technologies, TURP had been considered the gold standard of prostate interventions for people who require a procedure. This involves removing (part of) the prostate by inserting a resectoscope (cystoscope) through the urethra. However, after this endoscopic surgery the ejaculations are dry in about 65% of patients, unless a novel, ejaculation preserving, altered technique of TURP is applied. Simple prostatectomy can also be offered to men who have large prostates (>50 grams). This can be done by open technique, laparoscopically, or with robotic assistance. There are two types of transurethral resection of the prostate (TURP): the standard monopolar and the newer bipolar procedure. A 2019 Cochrane review of 59 studies, that included 8924 men with urinary symptoms due to benign prostatic hyperplasia, found that bipolar and monopolar TURP probably results in comparable improvements in urinary symptoms, as well as a similar erectile function, the incidence of urinary incontinence, and the need for retreatment. Bipolar surgery likely reduces the risk of TUR syndrome and the need for blood transfusion. Efforts to find newer surgical methods have resulted in newer approaches and different types of energies being used to treat the enlarged gland. However some of the newer methods for reducing the size of an enlarged prostate, have not been around long enough to fully establish their safety or side-effects. These include various methods to destroy or remove part of the excess tissue while trying to avoid damaging what remains. Transurethral electrovaporization of the prostate (TVP), laser TURP, visual laser ablation (VLAP), ethanol injection, and others are studied as alternatives.

Minimally invasive therapies Minimally invasive therapies can offer faster recovery compared with traditional prostate surgery. They can further be divided into laser surgery (requiring spinal anesthesia) and other non-laser procedures.

Prostate laser surgery Prostate laser surgery is used to relieve moderate to severe urinary symptoms caused by prostate enlargement. The surgeon inserts a scope through the penis tip into the urethra. A laser passed through the scope delivers energy to shrink or remove excess tissue that is preventing urine flow. Different types of prostate laser surgery include:

Visual laser ablation of the prostate (VLAP) technique involving the Nd:YAG laser with contact on the prostatic tissue. Photoselective Vaporisation of the Prostate (PVP). A laser is used to melt away (vaporize) excess prostate tissue and enlarge the urinary channel. A high-power 180-watt 532 nm wavelength laser with a 650-micrometre laser fiber is used. This fiber has an internal reflection with a 70-degree deflecting angle. It is used to vaporize the tissue to the prostatic capsule. GreenLight 532 nm lasers target haemoglobin as the chromophore and typically have a penetration depth of 0.8 mm (twice as deep as holmium). Holmium Laser Ablation of the Prostate (HoLAP) is similar to PVP but uses a different type of laser. HoLAP uses a 550 um disposable side-firing fiber that directs the beam from a high-power 100-watt laser at a 70-degree angle from the fiber axis. The holmium wavelength is 2,140 nm, which falls within the infrared portion of the spectrum and is invisible to the naked eye. Whereas GreenLight relies on haemoglobin as a chromophore, water within the target tissue is the chromophore for Holmium lasers. The penetration depth of Holmium lasers is <0.4 mm, avoiding complications associated with tissue necrosis often found with the deeper penetration and lower peak powers of Nd:YAG lasers used in the 1990s. Laser Enucleation of the Prostate is used to cut and remove the excess tissue that is blocking the urethra. In the past, a Holmium laser has been traditionally used. Today however Thulium lasers are preferred because of their higher power and efficiency. Another instrument is then used to cut the prostate tissue into small pieces that are easily removed. Enucleation can be an option for men who have a severely enlarged prostate and is the only prostate size-independent treatment option approved by the American Urologic Association. Laser enucleation is largely similar to the HoLAP procedure; the main difference is that instead of ablating the tissue, the laser cuts a portion of the prostate, which is then cut into smaller pieces and flushed with irrigation fluid. As with the HoLAP procedure, there is little bleeding during or after the procedure. Three 2015 reviews found that HoLEP is superior to TURP in some respects and for some patients. Both wavelengths, GreenLight and Holmium, ablate approximately one to two grams of tissue per minute. Post-surgical care often involves placement of a Foley catheter or a temporary prostatic stent to permit healing and allow urine to drain from the bladder.

Non-laser treatments These procedures are typically performed with local anesthesia, and the patient returns home the same day. Some urologists have studied and published long-term data on the outcomes of these procedures, with data out to five years.

Transurethral microwave thermotherapy Transurethral microwave thermotherapy (TUMT) was originally approved by the United States Food and Drug Administration (FDA) in 1996, with the first generation system by EDAP Technomed. Since 1996, other companies have received FDA approval for TUMT devices, including Urologix, Dornier, Thermatrix, Celsion, and Prostalund. Multiple clinical studies have been published on TUMT. The general principle underlying all the devices is that a microwave antenna that resides in a urethral catheter is placed in the intraprostatic area of the urethra. The catheter is connected to a control box outside of the patient's body and is energized to emit microwave radiation into the prostate to heat the tissue and cause necrosis. It is a one-time treatment that takes approximately 30 minutes to 1 hour, depending on the system used. It takes approximately 4 to 6 weeks for the damaged tissue to be reabsorbed into the patient's body.

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Illustrations

Worked examples

Example 1 — a first encounter with Surgery for benign prostatic hyperplasia

Start with the simplest possible case. Write down what Surgery for benign prostatic hyperplasia claims or describes in one sentence, then invent the smallest concrete situation in which that sentence is true. In science, the smallest case is usually a single object, a single equation or a single measurement. Check that every symbol or term in your sentence has a meaning in that case.

Example 2 — changing one variable

Take the situation from Example 1 and change exactly one quantity: double it, halve it, or set it to zero. Predict what should happen to Surgery for benign prostatic hyperplasia before you calculate. Comparing your prediction with the result is the fastest way to find out whether you understand the idea or only the words.

Example 3 — an exam-style question

Typical questions about Surgery for benign prostatic hyperplasia ask you to (a) state it precisely, (b) apply it to given data, and (c) explain a limitation. Practise writing all three answers in under five minutes; the third part is what separates a full-mark answer from an average one.

Applications of Surgery for benign prostatic hyperplasia

In research: Surgery for benign prostatic hyperplasia appears in science research whenever the underlying quantities have to be modelled precisely. Papers usually cite it as a starting assumption and then explore where it breaks down.
In technology and industry: Engineering practice reuses Surgery for benign prostatic hyperplasia in design rules, simulations and safety margins. Knowing the idea lets you read a specification sheet and understand why the numbers look the way they do.
In the classroom: Surgery for benign prostatic hyperplasia is common in secondary-school and first-year university syllabi. It links to neighbouring topics Male genital surgery, Prostatic procedures, so understanding it makes those chapters shorter.
In everyday life: Look for Surgery for benign prostatic hyperplasia outside the textbook — in sport, cooking, traffic, electronics or the sky above you. An example you found yourself is remembered far longer than one you were given.

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How to study Surgery for benign prostatic hyperplasia in 20 minutes

Read the reference excerpt below once, without taking notes.
Close the page and write down what Surgery for benign prostatic hyperplasia means in your own words.
Compare your version with the excerpt and mark what you missed.
Work through the three examples above with pen and paper.
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Frequently asked questions

What is Surgery for benign prostatic hyperplasia in simple terms?

If medical treatment is not effective, surgery may need to be performed for benign prostatic hyperplasia. Invasive therapies There are two invasive surgical procedures done for BPH: Transurethral resection of the prostate (TURP): In general prior to emergence of laser technologies, TURP had been co…

Why does Surgery for benign prostatic hyperplasia matter?

Because it connects several science ideas at once: it gives you a definition you can apply, a quantity you can calculate, and a way to check whether a result is plausible.

How should I study Surgery for benign prostatic hyperplasia?

Read the excerpt, restate it from memory, then work through the examples and applications listed on this page. The five-step study plan above takes about twenty minutes.

What does this page cover?

It gives you a compact reference excerpt plus original lgStudy explanations, examples, applications and study material on Surgery for benign prostatic hyperplasia.