BPH Surgery in Mumbai (TURP, LASER, Robotic)

The prostate gland is a walnut-sized organ located below the urinary bladder and surrounding the urethra.

Benign Prostatic Hyperplasia (BPH), also known as Benign Prostate Enlargement (BPE), is a non-cancerous enlargement of the prostate gland that commonly develops after the age of 40–50 years.

As the prostate enlarges, it narrows the urinary passage and creates resistance to urine flow.

By the age of 60 years:

• Approximately 50% of men develop prostate enlargement.
• Nearly 90% of men are affected by age 85 years.
• About half eventually require treatment.

BPH develops due to age-related hormonal changes within the prostate gland.

Risk factors include:

• Increasing age
• Family history
• Diabetes mellitus
• Obesity
• Metabolic syndrome
• Sedentary lifestyle

Men over 50 years of age and those experiencing urinary symptoms should undergo evaluation by a urologist.

The prostate surrounds the urethra, the tube that carries urine from the bladder to the outside of the body.

As the prostate enlarges, it gradually compresses the urethra. The bladder must then generate greater pressure to push urine through the narrowed passage.

This can lead to:

• Slow urine flow
• Difficulty starting urination
• Frequent urination
• Interrupted stream
• Urinary urgency
• Incomplete bladder emptying
• Nighttime urination

Over time, persistent obstruction can weaken bladder function and contribute to long-term complications.

Difficulty Passing Urine

Common symptoms include:

• Reduced urine flow
• Difficulty initiating urination
• Straining while urinating
• Interrupted stream
• Dribbling urine
• Feeling of incomplete bladder emptying

Difficulty Storing Urine

Patients may also experience:

• Increased urinary frequency
• Waking multiple times at night
• Urinary urgency
• Difficulty controlling urine
• Occasional leakage

Complications of BPH

Acute Urinary Retention

A complete inability to pass urine associated with discomfort and pain requiring urgent catheter placement.

Chronic Retention and Kidney Damage

Persistent incomplete bladder emptying can affect kidney drainage and kidney function.

Other Complications

• Recurrent urinary infections
• Bladder stones
• Blood in urine

Even when symptoms appear mild, monitoring remains important to prevent progression.

Accurate diagnosis helps determine symptom severity and select the most appropriate treatment.

Evaluation may include:

Symptom Score Assessment

The IPSS-AUA Symptom Score helps measure symptom severity.

Prostate Examination

Digital rectal examination assesses prostate size and detects abnormal findings.

Urine Analysis

Helps identify infection or blood in the urine.

Uroflowmetry

Measures urine flow speed and the degree of urinary obstruction.

PSA Blood Test

Assesses prostate health and evaluates prostate cancer risk.

Ultrasound Examination

Evaluates:

• Prostate size
• Bladder wall thickness
• Residual urine volume
• Kidney health
• Hydronephrosis

Not every patient with BPH requires surgery.

However, surgery may become necessary when:

Symptoms Continue Despite Medication

Persistent urinary symptoms despite appropriate medical treatment.

Recurrent Acute Urinary Retention

Two or more episodes of urinary retention.

Chronic Retention With Kidney Damage

Significant obstruction affecting kidney function.

Bladder Stones

Stone formation due to poor bladder emptying.

Recurrent Bleeding in the Urine

Repeated episodes of visible blood in urine.

Recurrent Urinary Infections

Repeated infections caused by incomplete bladder emptying.

Poor Quality of Life

Persistent sleep disturbance, travel limitations, and reduced daily comfort.

Men who do not wish to remain on lifelong medication may also choose surgery.

All modern Benign Prostatic Hyperplasia Surgery procedures offer excellent success rates exceeding 90%.

Transurethral Resection of the Prostate (TURP Surgery)

TURP Surgery remains the traditional gold-standard treatment.

During the procedure:

• A camera and endoscope are inserted through the urinary passage.
• The obstructing prostate tissue (adenoma) is removed.
• No external incisions are required.
• Bipolar technology allows safe treatment of larger prostates.

Benefits include:

• Excellent urinary flow improvement
• Durable symptom relief
• Better bladder emptying
• Improved quality of life

Most patients require a catheter for 2–3 days after surgery.

Laser Prostate Surgery is especially useful for:

• Very large prostates (>80 grams)
• Patients taking blood-thinning medications
• Patients at increased bleeding risk

Benefits include:

• Less blood loss
• Faster recovery
• Shorter catheter duration
• Excellent symptom improvement
• Reduced hospital stay

Procedure selection depends on multiple factors including:

Prostate Size

Smaller and moderate-sized prostates are often treated with TURP Surgery or Laser Prostate Surgery, while larger glands may require Robotic Simple Prostatectomy.

Symptom Severity

The impact of symptoms on quality of life influences treatment decisions.

Bladder Function

Healthy bladder function improves long-term outcomes.

Medical Conditions

Existing illnesses and medications affect procedural planning.

Patient Expectations

Treatment goals and personal preferences remain important considerations.

Selecting the most appropriate surgical treatment requires careful evaluation of prostate size, urinary symptoms, bladder function, overall health, and previous treatments.

Dr Vivek Venkat completed advanced fellowship training in Uro-Oncology and Robotic Surgery at the internationally renowned University of Miami Miller School of Medicine, USA. A Gold Medalist in M.Ch. From Christian Medical College, Vellore, he has participated in more than 800 robotic procedures and has extensive experience in advanced minimally invasive urological surgery.

His expertise includes:

• Benign Prostatic Hyperplasia Surgery
• TURP Surgery
• Laser Prostate Surgery
• Robotic Simple Prostatectomy
• Advanced Prostate Surgery
• Robotic Urological Procedures
• Complex urinary tract disorders

This individualized approach helps ensure that every patient receives the most appropriate treatment for long-term symptom relief.

Modern prostate surgery is extremely safe and effective. However, complications can occasionally occur.

Bleeding

Mild bleeding is common. Significant bleeding requiring transfusion or a second procedure is uncommon and occurs in less than 1% of patients.

Urinary Infection

Most infections are mild and respond well to antibiotics.

Temporary Urinary Difficulty

Patients with weak bladder muscles may require catheterization for a longer period.

Frequency and Urgency

After catheter removal, temporary burning, frequency, and urgency are common and generally improve within 1–2 weeks.

Retrograde Ejaculation (Dry Orgasm)

Occurs in approximately 90% of men after surgery. Semen enters the bladder during orgasm rather than exiting through the penis. This is harmless and does not affect sexual pleasure.

Urinary Incontinence

Temporary leakage may occur following laser or robotic surgery for very large prostates and usually improves with time.