Ask the Doctor: ‘My husband suffers from an enlarged prostate. He’s on medication, but it seems to be becoming less effective. Is there anything else that can be done?’

“My husband suffers from an enlarged prostate and is frequently up during the night to use the bathroom. He is on medication from his GP for this but it seems to be becoming less effective over the past few months. Is there anything else that could be done for him?”

Answer from Dr. Michel de Wildt, Consultant Urologist in Beacon Hospital. He is specialised in treating men with urinary symptoms due to an enlarged prostate.

Benign enlargement of the prostate (which encircles the peeing tube and can lead to restriction of urinary flow out of the bladder) can cause bothersome urinary symptoms that affect quality of life by interfering with normal daily activities and sleep patterns. It remains one of the most common conditions affecting aging men.

Initial treatment usually starts with medication. Over time however, most men will notice the medication to be less effective and seek a more definitive solution.

Historically a TURP (TransUrethral Resection of the Prostate), was considered the surgical treatment of choice. Although TURP is effective, side effects are common and mainly consist of bleeding during surgery and in the postoperative period. It usually takes 2 to 4 days before patients can be discharged after surgery. It can then take up to 6 weeks before the urine becomes completely clear. Sometimes severe bloody urine means a patient has to be re-admitted to hospital for additional treatment.

Furthermore, with TURP it is not always possible to remove the prostate obstruction completely. It may leave residual prostate tissue that can give rise to recurrent growth, usually after 8-10 years. These patients then present with recurrent urinary symptoms, sometimes even urinary retention and may need a second surgery.

Several alternatives to TURP have been tried in the last 25 years and treatments have come and gone. Not because they had more side effects than TURP, it was actually the opposite. In Ireland Rezum and Urolift are two of these less invasive treatment options that are available now. Unfortunately, the improvement and long-term effects appear to be limited and usually men will have to undergo surgery in time.

It has been shown that enucleation of the prostate (which completely removes the obstructive part of the prostate) has been the most beneficial surgical solution. There is now a novel surgical approach that actually achieves this with minimal side effects and significant shorter recovery time and hardly any blood loss during and after surgery.

This technique is called HoLEP ( Holmium Laser Enucleation of the Prostate). After HoLEP surgery, the majority of patients can have their (post-operative) bladder catheter removed the next day and they can be discharged. Usually, there are less complaints made in the first 6 weeks after this surgery compared with TURP. Long term results of HoLEP are also more permanent than after TURP.

When medication for urinary symptoms are not that effective anymore, this should be discussed with your GP. They can refer you to a urologist who can perform additional tests to see if surgical intervention like HoLEP is necessary.

Presently in Ireland, HoLEP is only offered in Beacon Hospital in Dublin.

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