Prostate Surgery: Modern Procedures and Areas of Application

The majority of men over the age of 50 develop an enlarged prostate. This is usually benign and is not caused by prostate cancer, but by the natural change in hormone levels with age. Nevertheless, benign prostatic hyperplasia (BPH) should be taken seriously, because the enlarged tissue of the inner prostate layer presses on the urethra and bladder. This can result in difficult urination and incontinence.

In the early stages, symptoms are usually treated with herbal substances (e.g. pumpkin seeds) or medication (e.g. alpha-blockers). If the symptoms cannot be adequately controlled with medication or if the medication is not tolerated, prostate surgery may be considered. The operation reduces the size of the prostate so that it no longer presses on the patient's urethra and bladder. If the enlarged prostate has already led to complications such as cystitis, bladder stones, urinary retention and urinary obstruction in the kidneys, prostate surgery is unavoidable.

Find Out More about Treatment Options for Prostate Surgery

Contact us for a consultation if you are experiencing symptoms of benign prostate enlargement or changes in your bladder function. We will gladly inform you about your individual diagnostic and treatment options as well as the various procedures available for prostate surgery.

+41 44 387 29 10

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Examinations and Preparations before a Prostate Operation

Even a slightly enlarged prostate can restrict the outflow from the bladder and cause the typical symptoms of benign prostate enlargement. These range from a weak or interrupted urinary stream to a residual urinary sensation due to incomplete emptying of the bladder and a frequent urge to urinate occurring during the day and at night. A sudden urge to urinate that cannot be held back, resulting in an incontinence, can also be the result of benign prostatic hyperplasia.

Treatment begins with a medical history, a thorough examination of the patient and consideration of all treatment options. If prostate surgery is necessary, the urologist will provide the patient with comprehensive information about the operation, available methods and their individual risks.

Examinations for an Enlarged Prostate

The urologist carries out a series of examinations to clarify prostate enlargement. These include, for example

an ultrasound examination,
the rectal palpation examination
and a blood test.

During the blood test, the PSA value is determined in order to rule out cancer. The treatment of prostate cancer requires a completely different approach to the treatment of benign prostate enlargement. In the case of prostate cancer, not only the tumor but the entire prostate is removed (radical prostatectomy). In the treatment of benign prostate enlargement, however, only the inner part of the prostate is removed, leaving the outer part intact. If the enlargement is only slight, the entire tissue can sometimes be preserved.

Information and Preparation before Surgery

In the run-up to the prostate operation, the doctor will inform the patient in detail about the course of the operation and its prospects of success, possible risks and health consequences. The patient will also be informed about pre- and post-operative care.

Blood values, blood pressure and cardiac activity (ECG) are also measured before the operation. If a patient regularly takes medication, the attending physician will decide before the operation whether and when this medication should be discontinued or replaced by another medication. Depending on the patient's situation, the procedure is performed either under general anesthesia or spinal anesthesia (local anesthesia of the nerves in the spinal cord).

What Prostate Surgery Methods are Available?

Prostate surgery is particularly suitable for patients who cannot be treated with medication due to allergies or the occurrence of side effects, or who have already experienced serious complications. In recent years, a number of prostate surgery methods have been established that enable unimpeded bladder emptying through a relatively minor procedure. Modern robot-assisted prostate surgery methods such as DaVinci surgery are also available today to perform the operation minimally invasively and with the highest precision.

Prostate Surgery for Minor Enlargement

TUIP: Bipolar Prostate Incision
If the prostate is slightly enlarged, a surgical incision of the prostate (bipolar prostate incision, TUIP) can be performed. This short procedure can be performed under general or spinal anesthesia. In the TUIP method, an optical device and a vaporization probe are inserted via the urethra, which is used to incise the prostate tissue in three places. The drainage pathway from the bladder is reopened. With the bipolar prostate incision, no tissue is removed and the ability to ejaculate is retained.
TUR-P: The Standard Procedure for Benign Prostate Enlargement
The standard procedure for prostate surgery, which has been tried and tested for decades, is transurethral resection of the prostate (bipolar TUR-P). The treatment is carried out by scraping out the prostate using an electric snare that is inserted through the urethra. By removing the tissue in the inner layer of the prostate, the outflow from the bladder is reopened. This procedure can be performed under general or spinal anesthesia.

Surgical Methods for a Severely Enlarged Prostate

Bipolar Enucleation: Vaporization
In recent years, new procedures have been successfully tested, for example the use of laser resection, laser enucleation or vaporization (evaporation). In the case of particularly enlarged prostates, the bipolar enucleation of the prostate tissue can alleviate the symptoms if the available medication is no longer sufficiently effective. Extensive surgical removal of the enlarged parts of the prostate can be performed under general anesthesia or spinal anesthesia. The procedure is performed using an electric vaporization probe.
Prostate Surgery with Preservation of the Ability to Ejaculate
With methods for treating benign prostate enlargement, erection and orgasm are generally preserved. This means that potency is not affected by any of the procedures. However, the ability to ejaculate is almost always lost when the glandular tissue is removed. If the ability to ejaculate is desired, so-called ejaculation-protective transurethral resection of the prostate and bladder neck can be performed. Not all men can undergo this type of prostate surgery. In a consultation before the procedure, the doctor will discuss in detail with the patient whether this prostate surgery method is an option.

Keyhole Method (Minimally Invasive) Using the DaVinci Surgical Robot

Robot-assisted prostate surgery using the DaVinci robot is a modern, minimally invasive method of treating benign prostate enlargement. It is performed under general anesthesia and requires only a few small incisions at the level of the navel. The doctor guides the surgical instruments through these incisions. The robot-assisted surgical system transmits the surgeon's hand movements to the instruments with ultra-precision. Thanks to the use of high-resolution 3D cameras, the doctor can see the surgical area in ten times magnification and in three dimensions. This allows him to make much smaller, more precise incisions. Robot-assisted prostate surgery using the DaVinci surgical robot is currently one of the best and most sustainable procedures for prostate surgery. The advantages of this surgical method include

less blood loss
less pain after the operation
minor scars
a shorter stay in hospital

Embolization of the Prostate - the Alternative to Surgery

Prostate embolization is an option for older men or men with diseases that limit their ability to undergo surgery. With the help of a catheter inserted through the blood vessels in the groin, the side branches of the artery supplying the prostate can be closed. As a result, the prostate shrinks and bladder emptying is easier for the patient again. This procedure is performed on an outpatient basis under local anesthesia - the patient can leave the clinic on the same day. Prostate embolization is a method that has been used successfully for over 20 years by doctors specializing in men's health.

Prostate Cancer Requires other Surgical Treatments

All of the prostate surgery methods listed are only suitable for treating benign prostate enlargement (benign prostatic hyperplasia, BPH). If you are diagnosed with prostate carcinoma (prostate cancer), other treatment methods are required, as the cancer affects the outer layer of the prostate and the diseased cells behave differently than in the case of benign enlargement. Ask a specialist for advice on treatment methods (e.g. radical prostatectomy).

Hospitalization and Aftercare

After the procedure, the patient usually stays in the clinic for between 5 and 7 days. Immediately after the prostate operation, the patient is monitored in a recovery room. In the days following the operation, the bladder is emptied using a bladder catheter. The catheter is removed before the patient leaves the clinic.

Patients should then make sure they drink enough throughout the day. In the following weeks, it is also important to carry out regular exercises to strengthen the pelvic floor muscles in order to maintain continence. As some men cannot perceive their pelvic floor or can only perceive it to a limited extent, aids such as biofeedback can be used during pelvic floor training. Physically strenuous activities and sport should be avoided within six weeks following the operation. Patients should also avoid cycling and motorcycling during this period.

As the outer layer of tissue is preserved when treating a benignly enlarged prostate, the risk of prostate cancer remains. Patients should therefore continue to attend cancer screening examinations with their urologist.

Consult Our Specialists for Information about Prostate Surgery Methods

Contact us for a consultation, and we will gladly provide you with information about your individual assessment and treatment options. The KontinenzZentrum Hirslanden is open Monday to Friday from 8 a.m. to 5 p.m. You can reach our centre (KontinenzZentrum Hirslanden) in Zurich by telephone on +41 44 387 29 10. You can also use our online appointment booking service!