One of the most common prostate problems for older men is benign prostatic hyperplasia (BPH). A condition that causes the prostate to increase in size, difficulty urinating, and other incontinence problems. 

What is BPH?

BPH is an age-associated prostate gland enlargement that can cause urination difficulty. It seems to be most common in men above the age of 60. The expansion of the prostate and surrounding tissue is known as benign prostatic hyperplasia, or BPH. Your prostate may enlarge with age, and when it becomes big enough to cause issues, it's called BPH. The urethra is compressed by the growing prostate, the wall of the bladder thickens, and the bladder may weaken and eventually lose its capacity to empty completely.

Common symptoms:

• Frequent urination
• Difficulty starting urination
• Weak urine stream
• Dribbling at the end of urination
• Loss of bladder control
• Not being able to fully empty the bladder.

The severity of the symptoms is not necessarily correlated with the prostate's size. Some people may experience severe symptoms if their prostates are slightly enlarged. Some people with greatly enlarged prostates may experience modest issues. Furthermore, some individuals with enlarged prostates have no symptoms at all.

BPH doesn't have a cure, but treatments can help with symptoms. Treatment options include:

• Lifestyle changes
• Reducing alcohol and caffeine
• Medication
• Taking medications such as 5-alpha-reductase inhibitors, alpha-adrenergic blockers, or phosphodiesterase-5 inhibitors 
• Surgery - transurethral resection of the prostate (TURP) or other types of surgery.

Transurethral resection of the prostate (TURP) has been the mainstay of BPH treatment in Australia. It is however associated with significant postoperative bleeding, requiring a 2-3 night stay to wash blood out of the bladder.

Holmium Laser Enucleation of the Prostate (HoLEP) is a valid alternative to TURP and open prostatectomy for the surgical treatment BPH. One of the main advantages of this endoscopic technique is its reduced post-operative bleeding which allows to shorten the need for continuous bladder irrigation and consequently for the length of hospital stay. Selected patients may even be discharged on the day of admission (day-case HoLEP). 

The benefits of HoLEP are wide:

1. Health economics: HoLEP shortens the hospitalisation following BPE surgery. Following the procedure, patients are usually discharged within 24 hours and in select patients as a day case procedure with same day discharge. 
2. Healthcare resources: Post-operative care following a TURP is labour intensive as the blood needs to be continually washed out from the bladder using normal saline irrigation fluid. These bags of irrigation fluid need to be constantly changed for 48 hours post procedure. HoLEPs mitigate the need for continuous irrigation and hence is less labour intensive in the post-operative period.
3. Patient satisfaction: Earlier return to the community enhances patient satisfaction. Also, the overall patient satisfaction following HoLEP procedures has been well received.
4. Lower complication rates: HoLEP also reduces the rates of bleeding, thereby reducing the overall time spent in hospital and the readmission rates. HoLEP also potentially reduces the incidence of nosocomial and catheter associated infections given the shorter duration of hospitalisation and catheterization (1).

About Dr Brendan Dias:

Dr Brendan Dias is a Melbourne trained Urological surgeon committed to the delivery of evidence based and patient centric urological care. Dr Dias is one of the few Urologists who holds specialist qualifications in Urology from three different countries. Read more on Dr Brendan Dias.

(1) https://pmc.ncbi.nlm.nih.gov/articles/PMC7093193/#:~:text=One%20of%20the%20main%20advantages,or%20antiplatelet%20drugs%20%5B16%5D.