8.NOV.2022 MIN READ | MIN READ

Suffering from urinary symptoms due to an enlarged prostate? There’s a way out. HoLEP and ThuFLEP are minimally invasive laser treatments for benign prostate hyperplasia that can help you regain your quality of life.

Are you frustrated by a frequent need to urinate, and having to wake up multiple times at night to do so? Or know someone who is? This article has a potential solution to the issue.

Chances are, benign prostate hyperplasia (BPH) is the cause of these inconveniences. This refers to the enlargement of the prostate gland that commonly affects men as they age. Unfortunately, it can come with a host of symptoms that may interfere with daily life.

Read on as Dr Lie Kwok Ying, urologist at Mount Elizabeth Novena Hospital, shares how minimally invasive treatments such as HoLEP and ThuFLEP can help address BPH.

1. What exactly is Benign Prostate Hyperplasia (BPH)?

Benign Prostate Hyperplasia (BPH)

BPH refers to the enlargement of the prostate gland.

Located just below the bladder, the prostate is a gland of the male reproductive system and contributes to the production of semen as well as its ejaculation from the body.

The prostate is one of the only organs that keeps growing as a man ages. As it grows, the enlarged prostate can start placing pressure on the bladder and urethra and choke off the urinary tract, thus leading to urinary symptoms.

Benign prostate hyperplasia growth comparison

Did you know? An enlarged prostate is one of the only organs in the human body that keeps on growing. A man’s prostate is about the size of a walnut when he is in his 20s. When a man turns 60, it may develop to the size of a lemon!

2. What are the tell-tale symptoms of BPH?

Frequent urination during periods of sleep

BPH symptoms include the following:

  • A weak, or an interrupted, urine stream
  • Trouble starting a urine stream
  • Dribbling at the end of urination
  • An increase in urinary frequency, up to 8 or more times a day
  • Urinary urgency, or being unable to delay urination
  • Nocturia, which refers to frequent urination during periods of sleep
  • Urinary retention
  • Urinary incontinence, which refers to the accidental loss of control of urine

3. What are the common minimally invasive treatments available for BPH?

Almost all the modern surgical treatments for BPH are done via the urinary tract and do not involve any incisions.

However, the term “minimally invasive treatment” in this case usually refers to treatments done with minimal anaesthesia, as an outpatient or day surgery procedure, and generally involves a quicker recovery.

Several minimally invasive procedures are available at the IHH Healthcare hospitals in Singapore for BPH and they can help to relieve the pressure that an enlarged prostate places on the urethra. These procedures include:

UroLift – involves the use of permanent physical implants to retract the prostate, thus relieving pressure on the urethra.

Rezum – involves targeting steam energy at enlarged prostate cells to enable its shrinkage.

The advantage of these treatments is the preservation of a man’s ability to ejaculate normally. However, there may still be a need for surgical treatment at a later point in life.

4. Tell us more about the new laser treatments, HoLEP and ThuFLEP. How do they work?

HoLEP stands for Holmium Laser Enucleation of the Prostate and ThuFLEP stands for Thulium Fibre Laser Enucleation of the Prostate.

These forms of treatment involve using a laser to cut (enucleate) the prostate tissue constricting a patient’s urethra. At the same time, the heat from the laser is used to close the blood vessels. Hence, this is why only a small amount of blood is lost during this type of surgery. The second part of the surgery, called morcellation, involves using surgical equipment to retrieve the prostate tissue from the bladder.

This can be achieved using either laser system, the Holmium Laser in HoLEP or the Thulium Fibre Laser in ThuFLEP. The choice of the laser depends on the expertise of your doctor and what is available in the hospital where the treatment is taking place.

Difference between HoLEP and ThuFLEP

The key difference between the two treatments lie in the type of laser system used. Studies do not show significant differences in clinical outcomes between the two treatments at the moment.

5. What are the benefits of HoLEP and ThuFLEP?

The benefits of laser enucleation treatments with HoLEP and ThuFLEP include the following:

  • The reduction of severe urinary symptoms, allowing the patient to pass urine more quickly, empty their bladders more completely and have less frequent bathroom visits.
  • Improvement in symptoms lasts longer than other BPH procedures.
  • Can be used to treat enlarged prostates of any size and shape. This is the only endoscopic procedure recommended for men with prostates larger than 80cc.
  • Less bleeding post-surgery as compared to a transurethral resection of the prostate (TURP).
  • Early discharge at between 1 – 2 days.
  • Unlike greenlight laser prostatectomy where there is a lack of prostate tissue for pathological analysis large quantities of prostate tissue are obtained during laser enucleation.
  • This is one of the most effective treatment option for men suffering from urinary retention.
  • Suitable for patients taking blood thinning medication for other conditions.

It is however, important for patients to discuss their individual situations and conditions with their doctor.

6. What are the side effects from HoLEP and ThuFLEP treatments that patients should be aware of?

The most common side effect of laser enucleation is temporary urinary incontinence. This may last anything from a few weeks to a few months but invariably gets better with time.

Other temporary side effects include: painful urination, blood in the urine, urgency or frequency in urination and urinary tract infection. When in doubt about the side effects you are facing, consult your doctor.

Even though the lasers are very effective in arresting bleeding vessels, there is still a small risk of a significant bleed. If a patient notices their urine colour appears like red wine after surgery, they should seek medical attention.

7. How can a patient take care of himself after a minimally invasive procedure for BPH?

Recovery after a minimally invasive procedure for BPH

I would advise patients who had prostate surgery to drink more fluids immediately in the first week or two after surgery. Fluids should not only be restricted to water. Isotonic drinks and coconuts can also be consumed as they also help to replace the electrolytes lost during treatment.

Patients are also advised to avoid strenuous exercises such as cycling, or heavy weight lifting (>5kg). They should also try to modify their diet to be higher in fibre so as to avoid constipation. We also advise avoiding sexual activities for 2 to 3 weeks after surgery.

It is also important to discuss with your doctor when to restart blood thinning medication such as aspirin.

8. How and when should one screen for prostate health concerns?

How to screen for prostate health concerns:

Screening for prostate cancer is done by doing a blood test called prostate-specific antigen (PSA), which can offer insights into any prostate concerns, such as an enlarged or inflamed prostate, or prostate cancer.

When to screen for prostate health concerns:

Both prostate cancer and BPH seems to run in some families, which suggests that in some cases there may be an inherited or genetic factor. Screening can pick up conditions at an early stage so treatment can have better outcomes.

With up to 50% of men over the age of 50 and up to 80% of men over the age of 80 experiencing lower urinary tract symptoms (LUTS) from BPH, I would advise men experiencing LUTS to consult a urologist.

 

Article contributed by Dr Lie Kwok Ying, urologist at Mount Elizabeth Novena Hospital

References

PSA Test. Mayo Clinic. Retrieved on 26 October 2022 from https://www.mayoclinic.org/tests-procedures/psa-test/about/pac-20384731

Prostate Enlargement (Benign Prostatic Hyperplasia). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Retrieved on 26 October 2022 from https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-benign-prostatic-hyperplasia#causes

Prostate problems. National Institute for Ageing. Retrieved on 26 October 2022 from
https://www.nia.nih.gov/health/prostate-problems

What’s the Recommended Age for a Prostate Exam? Healthline. Retrieved on 26 October 2022 from https://www.healthline.com/health/mens-health/age-for-prostate-exam

Understanding Prostate Changes: A Health Guide for Men. National Cancer Institute. Retrieved on 26 October 2022 from https://www.cancer.gov/types/prostate/understanding-prostate-changes

M. Duijn, M.C. Hovius, and L.M.S. Boevé. (2022, Sep). Intravesical protrusion of giant median prostatic lobe: A case report. Urol Case Rep. v.44: 102152. doi: 10.1016/j.eucr.2022.102152 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9272338/

8.NOV.2022
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Lie Kwok Ying
Urologist
Gleneagles Hospital