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Benign Prostate Conditions

Benign Prostatic Hyperplasia (BPH) / Enlarged Prostate

The enlarged prostate is not caused by cancer.

An enlarged prostate is very common in men over the age of 40 years old, with roughly half having symptoms.

The high bladder pressures and mechanical tension seen with BPH activates chemical pathways in the bladder to compensate for the obstruction. Whilst initially COMPENSATORY, left unchecked these become DECOMPENSATORY, with remodelling of the upper and lower urinary tract, fibrous changes in the bladder muscle, and functional impairment.

What is BPH?

Benign Prostate Hypertrophy (BPH), and the resulting Bladder Outlet Obstruction (BOO), is considered to be the genesis of many of the problematic male Lower Urinary Tract Symptoms (LUTS).

Terminology

Benign Prostate Hyperplasia (BPH)

Histological diagnosis – an increase in cell numbers when viewed under a microscope

Benign Prostate Enlargement (BPE)

Clinical diagnosis based on DRE  (finger exam)

Bladder Outlet Obstruction (BOO)

Clinical diagnosis of altered bladder function

Lower Urinary Tract Symptoms (LUTS)

Constellation of symptoms which is neither gender nor organ specific

Symptoms

Common symptoms include:

  • Weak stream
  • Hesitancy to urinate
  • Increased urinary urgency
  • Increased urinary frequency
  • Incomplete bladder emptying
  • Nocturia (waking at night to urinate)

Allowed to progress further, a man might then develop more severe symptoms:

  • Urinary tract infections
  • Urinary incontinence (leakage of urine)
  • Inability to urinate (catheter dependence)
  • Haematuria (blood in the urine)
  • Urinary tract infections
  • Bladder stones (crystalisation of stagnant urine until multi-centimetre stones form)
  • Bladder diverticulae (hernias in the bladder form)
  • Renal failure / need for dialysis
Investigations

The diagnosis of BPH is based on a detailed urinary tract history, a physical examination by Dr Symons or your GP, and with the aid of the International Prostate Symptom Score – please complete this and bring it with you to your appointment)

Common tests that might assist in your management include urine tests, blood tests including the PSA, and imaging (such as an ultrasound or CT).

Resources

Benign Prostatic Hyperplasia (BPH) Treatments

Results from published studies indicate that both medical treatment and endoscopic surgical treatments will improve the urinary symptoms in men suffering from BPH/LUTS. However, the magnitude of improvement differs between the various treatment options – surgical procedures provide the greatest improvement in symptoms due to a greater reduction in the bladder outlet obstruction. Surgical treatments also have a much greater likelihood of reducing the progression to the more severe symptoms. From a pre-emptive health point of view, reduction of bladder outlet obstructions decreases detrusor (bladder) pressures, and helps preserve the long term integrity of the bladder itself.

There are several treatments and procedures that can be undertaken to treat BPH, please see the details of each of these below. Following a detailed personalised consultation, Dr Symons will discuss which treatment option would be most appropriate for you.

Potential management options include:

REZUM

Urolift

Greenlight Laser

Transurethral Resection of the Prostate (TURP), or “rebore”

“Ejaculation-Sparing” TURP

Bladder Neck Incision

Our dedicated & caring team of professionals are here to help.

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REZUM

What is Rezum?

REZUM is a minimally-invasive surgical procedure used when prostate enlargement causes urinary troublesome symptoms. Unlike other treatments that involve cutting the prostate or placing artificial implants, REZUM uses the natural energy stored in water vapour (steam) to remove obstructing prostate tissue. REZUM offers fast, effective treatment for BPH, with the steam-treated tissue gently reabsorbed by the body’s immune system over the coming months.

This treatment improves the flow of urine from the bladder to the outside, decreasing urinary symptoms.

Compared to other available surgical treatment options, REZUM offers unique benefits :

  • Significantly lower risk of bleeding
  • Minimal changes in sexual function

REZUM is suitable for most prostate shapes and sizes and preserves a man’s ejaculatory function. This makes it a good treatment for most men, particularly younger men who don’t wish to risk the ejaculatory risks of TURP.

The advantages of REZUM include:

  • Minimally-invasive treatment– no cutting of the skin
  • No cutting of the prostate, so post-operative urinary bleeding risk is low.
  • No implant is left inside the body, decreasing the likelikood of irritation
  • Shorter anaesthetic time – REZUM can often be safely performed on patients who are not fit for more traditional surgery, such as TURP
  • Minimal discomfort
  • Day surgery procedure (for younger patients)
  • Rapid return to normal activities of life

Urinary symptoms that may improve after a Rez̄um treatment include: 

  • Hesitancy – problems starting the flow of urination
  • Weak flow, or stop-starting
  • Straining to pass urine
  • Frequent need to urinate
  • Night-time waking to urinate (nocturia)
  • Urgency – difficulty deferring a sudden urge to urinate
  • Incomplete bladder emptying – the sense of not quite finishing the job
Procedure Information

The REZUM steam treatment to the prostate is performed under anaesthesia. Depending on the patient’s age and indication for surgery, some men might benefit from an overnight stay in hospital.

When you return from theatre you will have:

  • A line in your arm for IV (intravenous) fluids.
  • A small tube in your penis (catheter) connected to a bag that will drain urine overnight. For many men, this will be their first experience with a catheter. Our trained team of nurses will make sure that you are comfortable with how to manage it before you leave hospital.
  • Pain is minimal, and if present can be controlled with simple tablet medication
Recovery & After Care
  • You can resume driving 24 hours after surgery.
  • It is important you maintain a good fluid intake (~ 2L/day) for a few weeks. Water is best. Alcohol is acceptable in moderation after you finish your post-operative antibiotics.
  • It is very normal to see small amounts of blood in the urine for the first few weeks.
  • Around 7-10 days after prostate surgery, some debris may come through when you pass urine as the “internal scabs” lift off. If worrisome bleeding does occur and persists, please contact Dr Symons or the hospital where you were operated on.
  • It is important to remember that despite REZUM treatment being minimally-invasive, it is still a surgical procedure on the prostate gland, which is surrounded by a rich blood supply. Haemorrhage, or fresh bleeding from the prostatic cavity, is a rare but potential complication of prostate surgery, even if there has been little blood following the operation. This can particularly occur if you do not give your body time to heal. So …. take it easy and avoid strenuous activity (e.g. golf, running, cycling, going to the gym, lawn mowing, etc…) for the first 2 weeks after surgery.
  • Avoid constipation and straining to pass stool. Similar to heavy lifting, this will increase your blood pressure and increased the risk of bleeding.
  • Sexual activity may be resumed around 2 weeks after surgery, and once the urine colour has returned to normal. Though REZUM treatment doesn’t alter the muscles involved with orgasm, the volume of ejaculatory emission may be reduced due to a decrease in the volume of gland tissue.
Things to do prior to Admission
  • Please bring to hospital any regular medications that you are on, ideally in their original packaging.
  • Please notify Dr Symons or SydneyUro if there is are any changes in your health before your operation, or if new medication is started.
  • Please notify Dr Symons if you are still required to take blood thinning medication.
  • Please discontinue Fish Oil or other herbal medicines, as these can interfere with anaesthesia and increase bleeding risks.
  • Keep your bowels regular. Increase water intake if required. Dr Symons can start patients on medication to assist with this in hospital.
  • Consider if any support or equipment may be need during your recovery period at home.
  • Depending upon your living arrangements, it may be helpful to have a few prepared meals at home for when you return home.
  • Please consider your mode of transport for going home before arrival to hospital, as you will not be able to safely drive yourself for 24 hours after the procedure.

Urolift

What is Urolift?

UroLift is the trade name for a technique of Prostatic Urethral Lift. This is a minimally-invasive treatment option for men with urinary symptoms due to BPH.

The treatment involves the placement of small permanent implants into the prostate that pulls it open, widening the channel that urine travels through.

The main benefit of the procedure is that it is minimally-invasive and has a more favourable side-effect profile compared a radical TURP operation.  The main benefit includes the minimal risk of causing sexual dysfunction post-operatively.

In keeping with the less aggressive nature of the UroLift, medical literature reports ~ 60-80% of men experience a 50% improvement in urinary symptom score.

 The UroLift procedure is suitable for men with symptoms from prostatic enlargement who:

  • do not benefit from, or cannot tolerate, oral medications
  • do not wish to risk changes in sexual function
  • do not want to have more invasive surgery (with higher surgical risks)
  • want to return to normal everyday activities rapidly (due to the low bleeding risk)

Before a patient can have a UroLift, Dr Symons undertakes an individualised patient assessment, including:

  • detailed overview of voiding function
  • prostate size and shape evaluation + flexible cystoscopy
  • evaluation for prostate cancer.
Procedure Information

The UroLift treatment to the prostate is performed under anaesthesia. Typically, you will go home on the day following the surgery.

Under anasethetic, a fine telescope in gently inserted through the penis until the prostate is reached. A sterile device is used to then place the implants between the inner and outer layers of the prostate, retracting it awayfrom the urethra. Similar to tailoring a pair of trousers, the implant is able to create a wider channel without any need for cutting.

Following the procedure, a catheter is routinely placed which will be removed the next morning. Approximately 10% of patients may have some swelling that requires the catheter to be temporarily put back.

Recovery & After Care
  • You can resume driving 24 hours after surgery. 
  • It is important you maintain a good fluid intake (~ 2L/day) for a few weeks. Water is best. Alcohol is acceptable in moderation after you finish your post-operative antibiotics.
  • It is very normal to see small amounts of blood in the urine for the first few weeks.
  • Around 7-10 days after prostate surgery, some debris may come through when you pass urine as the “internal scabs” lift off. If worrisome bleeding does occur and persists, please contact Dr Symons or the hospital where you were operated on.
  • It is important to remember that despite the UroLift treatment being minimally-invasive, it is still a surgical procedure on the prostate gland, which is surrounded by a rich blood supply. Haemorrhage, or fresh bleeding from the prostatic cavity, is a rare but potential complication of prostate surgery, even if there has been little blood following the operation. This can particularly occur if you do not give your body time to heal. So …. take it easy and avoid strenuous activity (e.g. golf, running, cycling, going to the gym, lawn mowing, etc…) for the first 2 weeks after surgery.
  • Avoid constipation and straining to pass stool. Similar to heavy lifting, this will increase your blood pressure and increased the risk of bleeding.
  • Sexual activity may be resumed around 2 weeks after surgery, and once the urine colour has returned to normal. Though a UroLift treatment doesn’t alter the muscles involved with orgasm, the volume of ejaculatory emission may be reduced due to a decrease in the volume of gland tissue.
Things to do prior to Admission
  • Please bring to hospital any regular medications that you are on, ideally in their original packaging.
  • Please notify Dr Symons or SydneyUro if there is are any changes in your health before your operation, or if new medication is started.
  • Please notify Dr Symons if you are still required to take blood thinning medication.
  • Please discontinue Fish Oil or other herbal medicines, as these can interfere with anaesthesia and increase bleeding risks.
  • Keep your bowels regular. Increase water intake if required. Dr Symons can start patients on medication to assist with this in hospital.
  • Consider if any support or equipment may be need during your recovery period at home.
  • Depending upon your living arrangements, it may be helpful to have a few prepared meals at home for when you return home.
  • Please consider your mode of transport for going home before arrival to hospital, as you will not be able to safely drive yourself for 24 hours after the procedure.

Greenlight Laser

What is Greenlight Laser Surgery?

For men with larger glands, or for whom blood-thinners cannot safely be discontinued for a prolonged period of time, Greenlight Laser Prostate Surgery offers a safe way to treat their lower urinary tract symptoms.

The obstruction usually occurs because of an enlargement of the prostate tissue (Benign Prostatic Hyperplasia, BPH). Many men experience this “enlargement” as they get older. It is when this enlarged tissue obstructs the normal flow of urine that men develop symptoms of a slow urinary stream, such as frequency of urination, a sense of incomplete bladder emptying, or hesitancy / difficulty starting the stream.

With Greenlight Laser Surgery, Dr Symons passes a fine instrument through the urinary passage (urethra) and uses a laser specially tuned to target the blood within the enlarged prostate tissue. The blood molecules take up the green laser energy and are instantly vaporised into CO2 gas. This opens a large channel to allow for smoother urinary flow, better bladder emptying, and decreased urinary bother.

Procedure Information

Greenlight Laser Surgery is performed under general anaesthesia and usually requires an overnight stay in hospital.

Laser Prostate Surgery is carried out using a surgical device called a cystoscope, which is a thin metal tube gently placed through the opening in the penis until the prostate comes into view. Within the cystoscope is a bright light, a High Definition camera and a laser fibre. By placing the telescope through the urethra, Dr Symons is able to aim the laser onto the prostate without the need for cuts to be made in your skin.

After the prostate has been treated, a small tube (catheter) is gently placed into the bladder to drain the urine overnight. When you return from theatre you will also have a line in your arm for intravenous fluids.

When the urine looks clear, the catheter is removed and once passing urine, the patient can go home to continue their convalescence there. As for any major surgery, it’s not uncommon to feel a bit tired for a week or so after going home. Whilst you are free to go about normal gentle household activities, it is best not to plan to do anything to vigorous over this period.

Contrary to expectations, PAIN IS MINIMAL. There can be a small amount of burning or stinging when passing urine for the first 1-2 weeks – Dr Symons will give you medicine to help with minimise this.

Recovery & After Care
  • You can resume driving a couple of days after surgery. 
  • It is important you maintain a good fluid intake (~ 2L/day) for a few weeks. Water is best. Alcohol is acceptable in moderation after you finish your post-operative antibiotics.
  • It is very normal to see small amounts of blood in the urine for the first few weeks.
  • Around 7-10 days after prostate surgery, some debris may come through when you pass urine as the “internal scabs” lift off. If worrisome bleeding does occur and persists, please contact Dr Symons or the hospital where you were operated on.
  • It is important to remember that despite Greenlight Surgery being minimally-invasive, it is still surgery on the prostate gland, which is surrounded by a rich blood supply. Haemorrhage, or fresh bleeding from the prostatic cavity, is a rare but potential complication of prostate surgery, even if there has been little blood following the operation. This can particularly occur if you do not give your body time to heal. So …. take it easy and avoid strenuous activity (e.g. golf, running, cycling, going to the gym, lawn mowing, etc…) for the first 2-4 weeks after surgery.
  • Avoid constipation and straining to pass stool. Similar to heavy lifting, this will increase your blood pressure and increased the risk of bleeding.
  • Sexual activity may be resumed around 2 weeks after surgery, and once the urine colour has returned to normal. Whilst most patients should still achieve an orgasm, the volume of ejaculatory emission may be reduced or absent.
  • Wear your compression stockings for the first few days you are at home.
Things to do prior to Admission
  • Please bring to hospital any regular medications that you are on, ideally in their original packaging.
  • Please notify Dr Symons or SydneyUro if there is are any changes in your health before your operation, or if new medication is started.
  • Please notify Dr Symons if you are still required to take blood thinning medication.
  • Please discontinue Fish Oil or other herbal medicines, as these can interfere with anaesthesia and increase bleeding risks.
  • Keep your bowels regular. Increase water intake if required. Dr Symons can start patients on medication to assist with this in hospital.
  • Consider if any support or equipment may be need during your recovery period at home.
  • Depending upon your living arrangements, it may be helpful to have a few prepared meals at home for when you return home.
  • Please consider your mode of transport for going home before arrival to hospital, as you will not be able to safely drive yourself for 24 hours after the procedure.

Transurethral Resection of the Prostate (TURP), or “rebore”

What is a TURP?

Transurethral Resection of the Prostate (TURP), colloquially known as a “rebore,” has been the mainstay of surgical treatment for urinary symptoms due to an enlarged prostate. Performed for over 30 years, it remains the ‘gold standard’, and in multiple clinical trials TURP yet to be bettered by any of the more modern treatments. However, a traditional TURP has been associated with complete loss of ejaculation in ~ 80% of men, and thus often doesn’t suit the lifestyle of younger men – for such men a REZUM or Urolift may be more appropriate.

Procedure Information

A TURP is carried out using a surgical device called a resectoscope, which is a thin metal tube gently placed through the opening in the penis until the prostate comes into view. Within the device is a light, a HD camera and a loop of wire, similar to that seen inside a light bulb. By placing the telescope through the urethra, Dr Symons is able to operate on the prostate without the need for cuts to be made in your skin.

 

“Ejaculation-Sparing” Transurethral Resection of the Prostate

For many men, Dr Symons can offer ejaculation preservation through careful anatomical dissection, whilst still greatly improving their urinary function. Dr Symons’ technique confers a balance between improvement in bothersome urinary symptoms whilst still preserving their normal sexual function.

However, just as humans come in all shapes and sizes, so to does the prostate gland! Unfortunately, some men are thus not suitable for this treatment. Following an assessment by Dr Symons he can see if this treatment is suitable for your particular situation.

After Dr Symons has placed the resectoscope up to the prostate, the metal loop of wire is superheated with an electric current. This is used to carefully dissect away the section of your prostate causing your symptoms. After the procedure is complete, a thin tube (called a catheter) is then gently inserted into your urethra to drip fluid into the bladder and makes sure no clots form.

So that you won’t feel anything during the procedure, a General or Spinal anaesthesia is used.

Most patients will usually need to stay in hospital for 2 nights after the operation.

When the urine looks clear, the catheter is removed and once passing urine, the patient can go home to continue their convalescence there. As for any major surgery, it’s not uncommon to feel a bit tired for a week or so after going home. Whilst you are free to go about normal gentle household activities, its best not to plan to do anything to vigorous over this period.

Contrary to expectations, PAIN IS MINIMAL. There can be a small amount of burning or stinging when passing urine for the first week – Dr Symons will give you medicine to help with minimise this.

Recovery & Aftercare
  • It is important you maintain a good fluid intake (~ 2L/day) for a few weeks. Water is best. Alcohol is acceptable in moderation after you finish your post-operative antibiotics.
  • It is very normal to see small amounts of blood in the urine for the first few weeks.
  • Around 7-10 days after prostate surgery, some debris may come through when you pass urine as the “internal scabs” lift off. If worrisome bleeding does occur and persists, please contact Dr Symons or the hospital where you were operated on.
  • It is important to remember that despite TURP treatment being a keyhole procedure, it is still an operative procedure on the prostate gland, which is surrounded by a rich blood supply. Haemorrhage, or fresh bleeding from the prostatic cavity, is a rare but potential complication of prostate surgery, even if there has been little blood following the operation. This can particularly occur if you do not give your body time to heal. So …. take it easy and avoid strenuous activity (e.g. golf, running, cycling, going to the gym, lawn mowing, etc…) for the first 4-6 weeks after surgery.
  • Avoid constipation and straining to pass stool. Similar to heavy lifting, this will increase your blood pressure and increased the risk of bleeding.
  • Sexual activity may be resumed around 2 weeks after surgery, and once the urine colour has returned to normal. Though TURP treatment doesn’t alter the muscles involved with orgasm, the volume of ejaculatory emission may be reduced due to a decrease in the volume of gland tissue. In men who need a more traditional TURP (non-ejaculation preserving), it is common for there to be NO emission after orgasm.
  • Whilst you can resume driving the day after you discharge from hospital, urinary urgency may be a feature in some men, so careful planning is needed for the first week or so.
Things to do prior to Admission
  • Please bring to hospital any regular medications that you are on, ideally in their original packaging.
  • Please notify Dr Symons or SydneyUro if there is are any changes in your health before your operation, or if new medication is started.
  • Please notify Dr Symons if you are still required to take blood thinning medication.
  • Please discontinue Fish Oil or other herbal medicines, as these can interfere with anaesthesia and increase bleeding risks.
  • Keep your bowels regular. Increase water intake if required. Dr Symons can start patients on medication to assist with this in hospital.
  • Consider if any support or equipment may be need during your recovery period at home.
  • Depending upon your living arrangements, it may be helpful to have a few prepared meals at home for when you return home.
  • Please consider your mode of transport for going home before arrival to hospital, as you will not be able to safely drive yourself for 24 hours after the procedure.

“Ejaculation-Sparing” TURP

What is an “Ejaculation-Sparing” Transurethral Resection of the Prostate?

Just as humans come in all shapes and sizes, so to does the prostate gland!

 

For the last 40 years, Transurethral Resection of the Prostate (TURP), colloquially known as a “rebore,” has been the mainstay of surgical treatment for urinary symptoms due to an enlarged prostate. It remains the ‘gold standard’, and in multiple clinical trials the traditional TURP has yet to be bettered by any of the more modern treatments. However, the traditional TURP has been associated with complete loss of ejaculation in ~ 80% of men, and thus often doesn’t suit the lifestyle preferences of younger men.

 

For younger men, or men who would like to preserve ejaculation where possible, Dr Symons is routinely offers minimally-invasive surgery. Depending on a patients clinical details, options include the intra-prostatic steam treatment (REZUM™️), prostatic-urethral lift (PUL / Urolift™️) and an ejaculation-sparing TURP.

 

Following a detailed assessment by Dr Symons, he can see if a minimally-invasive treatment is suitable for your particular situation. For many men, Dr Symons can offer ejaculation preservation through careful anatomical dissection, whilst still greatly improving their urinary function.

 

Dr Symons’ “ejaculation-sparing” TURP technique confers a balance between improvement in bothersome urinary symptoms whilst still preserving a man’s normal sexual function (erections & ejaculation).

 

Please note: Unfortunately, due to anatomical, functional or health issues, some men are not suitable for all treatment options. Dr Symons undertakes a careful pre-operative assessment to try to get the best possible outcome for his patients

Procedure Information

An ejaculation-sparing TURP is carried out using a surgical device called a resectoscope, which is a thin metal tube gently placed through the opening in the penis until the prostate comes into view. Within the device is a light, a high-definition camera and a loop of wire, similar to that seen inside a light bulb. By placing the telescope through the urethra, Dr Symons is able to operate on the prostate without the need for cuts to be made in your skin.

After Dr Symons has placed the resectoscope up to the prostate, the metal loop of wire is superheated with an electric current. This is used to carefully dissect away the section of your prostate causing your symptoms. Dr Symons is careful not to alter the anatomy responsible for the normal flow of ejaculatory secretions.

After the procedure is complete, a thin tube (called a catheter) is then gently inserted through your urethra into the bladder. Bladder irrigation with saline fluid is overnight to makes sure no clots form.

 

So that you won’t feel anything during the procedure, a General or Spinal anaesthesia is used.

 

Most patients will usually need to stay in hospital for 2 nights after the operation.

 

When the urine looks clear, the catheter is removed and once passing urine, the patient can go home to continue their convalescence there.

 

As for any major surgery, it’s not uncommon to feel a bit tired for a week or so after going home. Whilst you are free to go about normal gentle household activities, its best not to plan to do anything to vigorous over this period.

 

Contrary to expectations, PAIN IS MINIMAL. There can be a small amount of burning or stinging when passing urine for the first week – Dr Symons will give you medicine to help with minimise this.

Recovery & Aftercare
  • It is important you maintain a good fluid intake (~ 2L/day) for a few weeks. Water is best. Alcohol is acceptable in moderation after you finish your post-operative antibiotics.
  • It is very normal to see small amounts of blood in the urine for the first few weeks.
  • Around 7-10 days after prostate surgery, some debris may come through when you pass urine as the “internal scabs” lift off. If worrisome bleeding does occur and persists, please contact Dr Symons or the hospital where you were operated on.
  • It is important to remember that despite TURP treatment being a keyhole procedure, it is still an operative procedure on the prostate gland, which is surrounded by a rich blood supply. Haemorrhage, or fresh bleeding from the prostatic cavity, is a rare but potential complication of prostate surgery, even if there has been little blood following the operation. This can particularly occur if you do not give your body time to heal. So …. take it easy and avoid strenuous activity (e.g. golf, running, cycling, going to the gym, lawn mowing, etc…) for the first 4-6 weeks after surgery.
  • Avoid constipation and straining to pass stool. Similar to heavy lifting, this will increase your blood pressure and increased the risk of bleeding.
  • Sexual activity may be resumed around 2 weeks after surgery, and once the urine colour has returned to normal. Though TURP treatment doesn’t alter the muscles involved with orgasm, the volume of ejaculatory emission may be reduced due to a decrease in the volume of gland tissue. In men who need a more traditional TURP (non-ejaculation preserving), it is common for there to be NO emission after orgasm.
  • Whilst you can resume driving the day after you discharge from hospital, urinary urgency may be a feature in some men, so careful planning is needed for the first week or so.
Things to do prior to Admission
  • Please bring to hospital any regular medications that you are on, ideally in their original packaging.
  • Please notify Dr Symons or SydneyUro if there is are any changes in your health before your operation, or if new medication is started.
  • Please notify Dr Symons if you are still required to take blood thinning medication.
  • Please discontinue Fish Oil or other herbal medicines, as these can interfere with anaesthesia and increase bleeding risks.
  • Keep your bowels regular. Increase water intake if required. Dr Symons can start patients on medication to assist with this in hospital.
  • Consider if any support or equipment may be need during your recovery period at home.
  • Depending upon your living arrangements, it may be helpful to have a few prepared meals at home for when you return home.
  • Please consider your mode of transport for going home before arrival to hospital, as you will not be able to safely drive yourself for 24 hours after the procedure.

Bladder Neck Incision

What is a Bladder Neck Incision?

For some men, the prostate itself is not overly enlarged, but they still have issues passing urine.

In such men, a bladder neck incision (BNI) involves making a careful incision through the neck of the bladder using small  electric “spike”. Similar to a TURP (link to TURP), this is placed gently with assistance of a telescoping camera whilst the patient sleeps – no cutting of the skin is needed.

A bladder neck incision is an excellent option for

  • Men with tight bladder necks
  • Younger men with smaller prostate volumes

As for all prostate surgery, one operation does not suit all patients – Dr Symons carefully assesses his patients to ensure the best possible solution is chosen to ensure the best surgical outcome for all patients. 

Whilst the risk of ejaculatory dysfunction with BNI is low compared to TURP, the procedure is not suitable for men who have yet to complete their family.

Procedure Information

After Dr Symons has placed the telescope up to the bladder neck, an energy source is used carefully incise through the tight muscular fibres causing your symptoms.

After the procedure is complete, a thin tube (called a catheter) is then gently inserted into your urethra to drip fluid into the bladder and makes sure no clots form.

So that you won’t feel anything during the procedure, a General or Spinal anaesthesia is used.

Most patients will usually need to stay in hospital for 2 nights after the operation.

When the urine looks clear, the catheter is removed and once passing urine, the patient can go home to continue their convalescence there. As for any major surgery, it’s not uncommon to feel a bit tired for a week or so after going home. Whilst you are free to go about normal gentle household activities, its best not to plan to do anything to vigorous over this period.

Contrary to expectations, PAIN IS MINIMAL. There can be a small amount of burning or stinging when passing urine for the first week – Dr Symons will give you medicine to help with minimise this.

Recovery & Aftercare
  • It is important you maintain a good fluid intake (~ 2L/day) for a few weeks. Water is best. Alcohol is acceptable in moderation after you finish your post-operative antibiotics.
  • It is very normal to see small amounts of blood in the urine for the first few weeks.
  • Around 7-10 days after prostate surgery, some debris may come through when you pass urine as the “internal scabs” lift off. If worrisome bleeding does occur and persists, please contact Dr Symons or the hospital where you were operated on.
  • It is important to remember that despite TURP treatment being a keyhole procedure, it is still an operative procedure on the prostate gland, which is surrounded by a rich blood supply. Haemorrhage, or fresh bleeding from the prostatic cavity, is a rare but potential complication of prostate surgery, even if there has been little blood following the operation. This can particularly occur if you do not give your body time to heal. So …. take it easy and avoid strenuous activity (e.g. golf, running, cycling, going to the gym, lawn mowing, etc…) for the first 4-6 weeks after surgery.
  • Avoid constipation and straining to pass stool. Similar to heavy lifting, this will increase your blood pressure and increased the risk of bleeding.
  • Sexual activity may be resumed around 2 weeks after surgery, and once the urine colour has returned to normal. Though TURP treatment doesn’t alter the muscles involved with orgasm, the volume of ejaculatory emission may be reduced due to a decrease in the volume of gland tissue. In men who need a more traditional TURP (non-ejaculation preserving), it is common for there to be NO emission after orgasm.
  • Whilst you can resume driving the day after you discharge from hospital, urinary urgency may be a feature in some men, so careful planning is needed for the first week or so.
Things to do prior to Admission
  • Please bring to hospital any regular medications that you are on, ideally in their original packaging.
  • Please notify Dr Symons or SydneyUro if there is are any changes in your health before your operation, or if new medication is started.
  • Please notify Dr Symons if you are still required to take blood thinning medication.
  • Please discontinue Fish Oil or other herbal medicines, as these can interfere with anaesthesia and increase bleeding risks.
  • Keep your bowels regular. Increase water intake if required. Dr Symons can start patients on medication to assist with this in hospital.
  • Consider if any support or equipment may be need during your recovery period at home.
  • Depending upon your living arrangements, it may be helpful to have a few prepared meals at home for when you return home.
  • Please consider your mode of transport for going home before arrival to hospital, as you will not be able to safely drive yourself for 24 hours after the procedure.