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Specialist prostate treatment and care
Offering all Advanced Minimally Invasive Prostate Surgeries for Patients
BPH is a very common and natural condition that occurs as a man ages. About 50% of men will suffer symptoms related to BPH as they get older and about 20% will need medical or surgical intervention for BPH. There are a range of prostate surgery treatments available, each of which has benefits and possible side effects. Here at Gold Coast Urologist all of the latest techniques are on offer, however they need to be tailored to each patient based on their symptom severity caused by BPH, prostate shape and size, other medical conditions and obviously patient wishes. Here at Gold Coast Urologist, we offer all the latest prostate surgeries so can treat your prostate concerns with the most suitable procedure for you.
"Benign prostatic hyperplasia (BPH)...is a disease of ageing, affecting 40% of men in their 50s and 90% of men over 90 years" 1
Dr Martin Elmes has highlighted below the benefits and downsides of the possible prostate surgery treatments available to you for BPH and your prostate troubles.
Benign Prostatic Hyperplasia (BPH)
Urolift is a relatively new, minimally invasive technique designed to improve urinary symptoms caused by an enlarged prostate or BPH. Gold Coast urologist Dr Elmes, was one of the first surgeons in Queensland to perform it.
The procedure is carried out by inserting several small internal stitches into the prostate, compressing the tissue outwards and thus widening the internal diameter of the 'urethra' (the tube we naturally urinate out).
It does not involve cutting or lasering of any of the prostate tissue and as such results in a far better side effect profile:
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No Erectile Dysfunction
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No stress urinary incontinence
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No retrograde (backwards) ejaculation
Dr Elmes recommends urolift it to his patients with:
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mild to moderate urinary symptoms who want to stop daily tablets
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a fear of retrograde ejaculation
HoLEP (Laser prostate enucleation)
Holmium or thulium laser enucleation (HoLEP) is the new gold standard for BPH treatment (1). It is minimally invasive and follows the exact anatomical planes within a prostate with precision allowing complete resection of all adenoma (obstructing tissue) whilst preserving the outer capsule, erectile nerves and urethral sphincter.
Its short and longterm outcomes are superior to older style prostate surgery:
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less bleeding
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lower chance of erectile dysfunction or incontinence
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same maximal flow rate and urinary symptom improvement
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minimal re-operation rate
and to older style prostate lasers:
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Importantly allows sampling of tissue to look for cancer
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same low blood loss
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lower chance of incontinence
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greater improvement in flow rates and urinary symptoms
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lower re-operation rate
Gold Coast Urologist Dr Elmes recommends HoLEP for all his patients with moderately to severely bothersome symptomatic BPH that have:
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failed or do not wish to have medical therapy
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are willing to tolerate retrograde ejaculation
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that do not wish to undergo the older style TURP or re-bore
Robotic Enucleation of the Prostate
In some men with severely enlarged BPH, surgery to remove a large section of prostate tissue from around the urethra is recommended. This helps with very enlarged prostates (eg, over 100 grams or so, about 3X normal size) or when BPH causes serious obstruction and problems such as urinary retention, infection, blood or stones (calculi) in the bladder, or kidney damage performed with the da Vinci® Surgical System in a minimally invasive procedure. Robotic techniques allow more precise removal of the inner part of the prostate with smaller incisions, reduced blood loss, less need for blood transfusion, less pain, shorter hospital stay (2-3 days), and faster overall recovery before a return to normal activities.
The exact approach and incision locations depend on the prostate's size and the patient's symptoms and other conditions. In most procedures, the adenoma (the abnormally enlarged portion of the prostate) near the urethra is carefully resected (removed). Then remaining parts of the gland are sewn back together to restore the normal prostate capsule.
Watch Dr Elmes perform a Robotic Enucleation of the Prostate - Click Here
TURP or Re-bore
Transurethral resection of the prostate is a still a viable alternative for bladder outlet obstruction caused by BPH. It creates a wide open cavity using electrical energy to allow segmental cutting of of the obstructing prostate tissue which is then removed via the penis piecemeal.
It creates a good improvement in flow and reduction of urinary symptoms and has done so for many years, however newer advanced procedure just as the Laser treatments have offered patient with:
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lower bleeding/transfusion rate
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lower erectile dysfunction rate
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same improvement in urinary symptoms and flow rates.
Ref 1: Shvero A, Calio B, Humphreys MR, Das AK. HoLEP: the new gold standard for surgical treatment of benign prostatic hyperplasia. Can J Urol. 2021 Aug;28(S2):6-10. PMID: 34453422.
