For Extremely Large Prostates
There are a few procedures well suited to treat larger prostates – those over 90 grams. Aquablation and traditional TURP surgery can be good options. Today, a simple prostatectomy is perhaps best reserved for patients with extremely large prostates – those over 150 grams. Simple prostatectomy may also be appropriate for patients with lesser enlargement but who also have bladder stones, bladder diverticula, or when performed in combination with other surgical procedures like a cystectomy.
BPH / benign prostatic hyperplasia, also known as enlarged prostate, is as common as the aging process itself. Treatment options largely depend on the patient’s anatomy and the size of the prostate, and only a few procedures are effective for very large prostates. Despite the name, simple prostatectomy is not performed for the treatment of prostate cancer but instead used to treat the proliferation of prostatic cells causing Lower Urinary Tract Symptoms or LUTS.
A simple prostatectomy is performed in a minimally invasive manner using robotic surgical technology in a hospital setting and under general anesthesia. Unlike other modern BPH treatments, the surgery is performed through the skin using tiny incisions. We access the prostate using miniaturized tools, including a small camera through the bladder.
The surgeon proceeds to remove the inside or pulp of the prostate, known as the adenoma. The outer structural layer of the prostate, known as the capsule, is spared. The procedure requires between 60 and 90 minutes of operative time, and results can last up to seven years or more.
The field of urology was one of the first to embrace robotic surgical techniques due to the unparalleled visualization and dexterity that the robotic platform provides the surgeon. Your surgeon is always in complete control of the robotic platform, and the robot translates the surgeon’s hand movements within the body. While traditional laparoscopy has a limited range of motion, the robotic arms have wristed hinges, allowing 360-degree movement within the abdomen. This allows for detailed work on complex organs and straightforward treatment of smaller structures like the prostate.
Patients will stay in the hospital for one night as they recover from anesthesia and are observed for complications, of which there are few. Most patients will require a catheter for approximately a week, which is then removed at home. Patients will wake up to find a drain in their abdomen, which will be removed before leaving the hospital. Bleeding is the most common complication that may also lengthen the patient’s hospital stay by one night. Infection at the incision sites, significant pain, and blood loss can also occur, though infrequently.
Patients have more BPH options for very large prostates than ever before. Aquablation is another highly effective option for patients with larger prostates. Unlike other treatments, Aquablation does not require any skin incisions, making it a less invasive choice for many. Speaking to your urologist about the best option for your circumstance is important. Certain circumstances (anatomies and size) may require a specific procedure, but most patients will have multiple options to discuss with their urologic surgeon.
BPH symptoms and lifestyle impediments can range from mildly uncomfortable to debilitating, and patients need to know that there is no reason to wait for treatment. We have BPH treatment options appropriate for any level of obstruction and anatomy. From 5-minute in-office or ASC-based minimally invasive and convenient procedures include iTind, GreenLight Laser therapy, Optilume, Prostate Artery Embolization (PAE), Rezum, and Urolift, and to surgical options like traditional TURP, and Aquablation. The most crucial first step in treating BPH is scheduling a consultation with a qualified urologist.
After the BPH procedure, most patients experience rapid and long-lasting relief of their symptoms, and in most cases, when prostatic tissue does eventually regrow, a follow-up procedure can give them further years of relief.
