Can an Enlarged Prostate Be Too Big to Treat?

February 7, 2020

BPH, or enlarged prostate, is a common condition affecting men around the age of 50. Common symptoms of BPH may include straining to urinate, weak urine stream, dribbling at the end of urination, waking up at night multiple times to urinate, or the inability to empty your bladder. If you experience any or all of these urinary symptoms to the point where it’s taking away from your quality of life, now might be the time to seek BPH treatment.

During your initial BPH diagnosis and evaluation, your urologist may note that your prostate may be more enlarged than the normally enlarged prostate. As a result, the enlarged size of the prostate may get to the point where it is unable to be treated by conventional methods.

How large is too large to treat?

While there are multiple BPH treatment options available, sometimes a prostate may be too large to be treated by them. An average-sized prostate will usually measure around 30 grams for a male. And most BPH treatments will cover prostate sizes up to 60-80 grams.

But, what happens if your prostate is larger? Historically, if your prostate was too large to undergo procedures such as the TURP, urologists would often have to perform either open invasive surgery (requiring an abdominal incision) or robotic surgery (multiple small abdominal incisions) to perform a procedure known as a simple prostatectomy.

What is a Simple Prostatectomy?

A simple prostatectomy is a BPH procedure that is either performed open or robotically/laparoscopically (Da Vinci system) to remove the portion of your enlarged prostate that is responsible for causing your urinary symptoms.

Depending on the approach, you may either have a lower midline incision or multiple smaller incisions across your abdomen. Postoperatively, you may be required to stay in the hospital for a couple of days up to a week. You may also require a catheter to drain your bladder for 4-8 days to facilitate the healing process.
Following a simple prostatectomy, patients would oftentimes have to spend 3-4 days in the hospital for recovery and require a catheter to heal and drain their bladders. Although patients had decent outcomes at long term follow-ups, the prolonged hospital stay, prolonged need for catheterization and overall morbidity sometimes associated with a simple prostatectomy spurred the need for a more minimally invasive alternative.

HoLEP, or Holmium Laser Enucleation of the Prostate, was developed as an answer to this problem.

What is a HoLEP?

Holmium Laser Enucleation of the Prostate (HoLEP), is a minimally invasive procedure that is performed without the need for abdominal incisions to remove the portion of your prostate.

If your prostate were to be an orange, the HoLEP aims to core out the “fruit” portion of the prostate and leaves the “Peel” behind. Like a simple prostatectomy, there is no prostate size that cannot be treated. Postoperatively, patients typically spend one night in the hospital and are able to be discharged the following day without the need for a catheter.

Differences between a HoLEP and Simple Prostatectomy

There have been multiple head-to-head studies performed comparing the HoLEP to open or robotic simple Prostatectomies.

These studies have shown that when compared, HoLEP had:
– Significantly decreased hospitalization stays
– Decreased times and need for urinary catheter
– Decreased blood loss and need for blood transfusions
– Similar long term outcomes.

So in short, the truly minimally-invasive HoLEP procedure can achieve the same great functional outcomes than its more invasive counterpart, and with much better efficiency and lower morbidity.

Why isn’t the HoLEP widely available?

There are two main reasons why HoLEP is not as widespread. The first is the availability for training on the procedure. HoLEP was initially developed at large academic institutions where it has remained and it is only being taught at a select-few urology training programs across the United States. The second reason is that there is a steep learning curve to learn HoLEP.

However, Dr. Lawrence Tsai with Austin Urology Institute has been fortunate enough to experience the rigors of training in the HoLEP and has become a more than capable provider to deliver this far preferred treatment for an enlarged prostate.

Want the best? Get the best.

At the Austin Urology Institute, we never stop growing. Whether it’s adopting new techniques and BPH treatment methods or recruiting the brightest and most talented minds in urology, we are constantly pushing the boundaries of healthcare and medicine to ensure that you get what you deserve — a life without constantly having to go to the bathroom.

Stop wasting precious time waiting in the bathroom and getting up in the middle of the night. If you’re looking for an end to your urinary issues and BPH symptoms, contact us now by dropping a note or calling us at 512-694-8888.