From the age of 50, half of men have urinary symptoms that reflect a prostate problem,
such as enlargement of the gland.

The prostate is a chestnut-shaped gland responsible for manufacturing much of the
seminal fluid. Located in the pelvis, below the bladder, it is traversed by the urethra,
which allows the passage of urine to the outside. By increasing its size, it makes normal
urination difficult.

Although this glandular growth is usually benign (known as benign prostatic hyperplasia
or BPH), it is sometimes necessary to treat it to alleviate the most bothersome
symptoms and avoid complications.

The most common symptoms associated with BPH sometimes progress over time. Dr. Eduardo Mart n Oses, head of the Urology Service of the Ruber Juan Bravo Hospital
Complex, details that the most frequent are:

- Difficulty urinating, diminished caliber and force stream.

- Need to urinate more often and with greater urgency, sometimes at night.

- Sensation of not completely emptying the bladder.

- Drip when finished urinating.

The study of the pathology, as revealed by the Quironsalud urologist, is usually based on
the determination of a protein manufactured in the prostate (PSA) and a rectal examination. This is how we can distinguish between the dreaded prostate cancer and
benign hyperplasia.

Usually the evaluation of the patient is completed with an ultrasound of the urinary
system, blood and urine tests and a flowmetry or test that allows us to measure how
forcefully we are urinating.

Two pathways to treatment

Concerning, the Ruber expert Juan Bravo subtleties that it isn't generally vital, besides in
that frame of mind in which the patient experiences troublesome side effects or
difficulties, for example, urinary plot contaminations, weakened kidney capability, stone
development, draining while peeing or urinary maintenance, among others.

Assuming that treatment is vital, this urologist brings up that medications are utilized as
a first line of activity, and in the most progressive cases or where the pharmacology is
deficient, medical procedure is important, this being the choice that offers the best
control. of the side effects.

As revealed by the Spanish Association of Urology (AEU), "most current surgical
techniques are performed via the transurethral route (through the urinary duct),
achieving very good results in general", the most common technique being transurethral
resection of the prostate, which is achieved by introducing a device through the urethra
capable of removing the prostate.

Other techniques are laparoscopy (reserved for very large volume prostates); transurethral enucleation, where laser or electrical energy is used to separate the
hyperplastic area and then excise it; or transurethral vaporization, where the obstructive
tissue is vaporized preserving the outermost part of the gland.

Holep, the most advanced treatment

On the other hand, the head of the Urology Service at Ruber Juan Bravo advances that
prostatic enucleation is the most advanced technique that also avoids having to resort to
the most invasive techniques performed through the abdomen.

For enucleation, a high-power laser and the latest generation, the Holmium laser
(HOLEP, Holmium Laser Enucleation of the Prostate), is usually used. "This is one of the
most advanced treatments that exist to treat benign prostatic hyperplasia and is
especially useful in large prostates", emphasizes Dr. Mart n Oses.

In his opinion, this treatment offers better results compared to other techniques,
allowing surgery to be carried out in less surgical time and with longer lasting results,
unlike other techniques that may require reinterventions due to residual tissue growth.

"Using a Holmium laser, the prostate tissue that has grown and obstructs the flow of
urine from the bladder to the outside is separated, to later extract and analyze it,
preserving the external capsular structure of the prostate gland", details the head of the
Urology Service. by Ruber Juan Bravo.

One of the main advantages offered by the HOLEP technique is that it is a minimally
invasive procedure that, without the need for external incisions, allows the treatment of
prostates of all sizes, even large prostates, of more than 70 cubic centimeters in which
other transurethral techniques are not as indicated and which were usually treated with
open or laparoscopic surgery.

Rule out cancer

Unlike some of the other types of laser used, such as the green laser, for the treatment
of benign prostatic hyperplasia, this urologist highlights that the HOLEP allows
pathological analysis of the removed tissue to rule out the existence of cancer.

"The enucleated tissue, separated from the prostate capsule by laser, is suctioned by
means of an instrument called a 'morcellator' that allows the removal of the adenoma
(prostate tissue that has grown and is responsible for the symptoms) through the
urethra and without performing any type of incision (as it happens in open surgery)",
explains this expert.

Other advantages, according to the doctor, are that it is a very safe intervention with a
minimal risk of significant bleeding and a low rate of complications. "In addition, it allows
rapid relief of urinary symptoms with early recovery and return to daily life, without
causing sexual impotence and with a minimal risk of urinary incontinence".

More info... https://whydoestheprostatehurt.quora.com/The-most-advanced-technique-to-treat-the-
prostate-without-risks

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