Benign Prostatic Hyperplasia Specialists

Benign Prostatic Hyperplasia (BPH) is a common condition as men age, where the prostate gland enlarges and compresses the urethra. This blockage restricts normal urinary flow, leading to symptoms like weak stream, frequent nighttime urination, and incomplete bladder emptying.

When conservative measures or medications no longer provide adequate relief, procedural options can physically open the urinary channel. Surgeons with Associated Urologists of North Carolina are highly trained to provide outpatient, tissue-preserving therapies to advanced laser and robotic interventions.

1. Transurethral Resection of the Prostate (TURP)

Long considered the ‘Gold Standard’ for surgical BPH treatments, TURP physically removes excess tissue obstructing the urethra.

• How It Works: A rigid scope is passed through the urethra under anesthesia. An electrified wire loop trims away obstructive tissue piece by piece while cauterizing blood vessels.
• Prostate Size: Most effective for small-to-moderate prostates (<80 grams).
• Recovery: 1–2 days in the hospital; requires temporary catheterization.
• Pros: Decades of clinical evidence demonstrating significant and durable improvement in urinary flow.
• Considerations: Higher rate of retrograde ejaculation (dry orgasm) and temporary bleeding risks compared to newer modalities.

2. Advanced Laser Therapies- GreenLight™ Laser Photovaporization (GLLP)

GreenLight laser therapy uses high-energy laser light to instantly vaporize prostate tissue with minimal bleeding.

• How It Works: A small laser fiber is inserted through the urethra to target obstructive tissue. The laser energy is absorbed by blood vessels, heating and vaporizing prostate tissue instantly while sealing nearby blood vessels.
• Prostate Size: Ideal for small-to-large prostates (<80 grams).
• Recovery: Typically performed as an outpatient or overnight procedure with short catheter times.
• Pros: Minimal blood loss, making it a strong choice for patients taking blood thinners.
• Considerations: Temporary post-procedure burning or urgency during early recovery.

3. Holmium Laser Enucleation of the Prostate (HoLEP)

HoLEP is an endovascular surgical procedure designed to treat prostates of virtually any size.

• How It Works: Using a high-power holmium laser, the surgeon separates and strips (enucleates) whole lobes of prostate tissue away from its outer capsule. A specialized tool (morcellator) breaks the tissue into small pieces inside the bladder to safely extract it.
• Prostate Size: Exceptional for large to extremely large prostates (>80 grams), avoiding open surgery.
• Recovery: 1-day hospital stay or outpatient discharge; fast recovery time.
• Pros: Extremely low rate of retreatment; removes full tissue samples for routine pathology checking.
• Considerations: Demands advanced technical expertise and specialized surgical training. Higher rate of retrograde ejaculation (dry orgasm).

4. Robotic & Image-Guided Therapies- Aquablation® Therapy

Aquablation combines real-time ultrasound imaging with autonomous robotics to remove prostate tissue using heat-free waterjet technology.

• How It Works: The surgeon creates a precise 3D map of the prostate using combined cystoscopic and ultrasound imaging. A computer-controlled, high-velocity waterjet then removes the pre-targeted tissue without thermal heat.
• Prostate Size: Effective across all prostate sizes and complex anatomies.
• Recovery: Brief hospital stay (1–2 days); low risk of thermal damage to surrounding structures.
• Pros: Combines high surgical precision with an exceptionally low rate of permanent sexual dysfunction.
• Considerations: Requires general or spinal anesthesia in a surgical setting.

6. Surgical Abdominal Approaches- Simple Prostatectomy (Open, Laparoscopic, or Robotic-Assisted)

For extraordinarily large prostates, abdominal entry remains a definitive treatment option.

• How It Works: Rather than working through the urethra, the surgeon accesses the prostate via small abdominal ports (robotic/laparoscopic) or an open incision to enucleate the inner obstructive core while leaving the outer capsule intact.
• Prostate Size: Reserved for larger prostates (>80 grams) or cases with concurrent large bladder stones.
• Recovery: 1-2 days in the hospital with a longer overall recovery timeline.
• Pros: Highly effective and definitive long-term relief for massive prostate enlargement.
• Considerations: Most invasive approach with higher overall recovery demands.