What is Benign Prostatic Hyperplasia (BPH)?
The prostate is a walnut sized gland that sits just below the bladder in men. As men age, the prostate naturally grows larger. In many men, this growth eventually presses on the urethra, the tube that carries urine from the bladder out of the body, causing it to narrow and restrict urine flow.
This condition is called benign prostatic hyperplasia, or BPH. It is not cancer. But it causes symptoms that can significantly affect daily life.
Common symptoms of BPH include a weak or slow urine stream, needing to strain to start urination, feeling like the bladder never fully empties, waking up multiple times at night to urinate, a sudden urgent need to urinate, and in severe cases, complete inability to pass urine.
When is Surgery Recommended?
Not every man with BPH needs surgery. Many men manage well with medications for years. Surgery becomes a reasonable option when:
- Symptoms have not improved adequately despite appropriate medication use
- Medications are causing side effects that reduce quality of life
- Recurrent urinary tract infections are linked to poor bladder emptying
- Bladder stones have formed due to chronic retention
- Kidney function is being affected by back pressure from a blocked bladder
- The man prefers a definitive solution over long-term medication
A proper assessment before any surgical decision generally includes a review of symptoms and medical history, a physical examination, urine flow testing (uroflowmetry), and post-void residual measurement. A PSA blood test and urodynamic studies are used in selected patients based on individual clinical findings, not as a routine requirement for everyone.
Types of Endoscopic Prostate Surgery Available in Bangalore
Transurethral Resection of the Prostate (TURP)
TURP has been the most widely performed surgery for BPH for decades and remains a well-established and effective treatment. A thin instrument called a resectoscope is passed through the urethra to the prostate. It uses electrical energy to cut away the excess tissue that is blocking the flow of urine. The tissue fragments are then washed out.
TURP works well for most prostate sizes, and experienced surgeons can perform it on larger glands too. That said, as prostate size increases, other techniques such as HoLEP are often preferred because they tend to be more efficient for larger volumes. Published data show TURP achieves meaningful symptom score (IPSS) improvement, with retreatment rates in the range of 7 to 8% at five years in several studies, though exact figures vary by patient group and follow up period.
Most patients have a catheter in place for one to two days after TURP and are discharged within two to three days. Urine flow typically improves noticeably within the first few weeks.
HoLEP: Holmium Laser Enucleation of the Prostate
HoLEP uses a Holmium laser passed through the urethra to separate and remove the inner obstructing portion of the prostate. Rather than cutting away tissue piece by piece, the technique enucleates, meaning it removes the obstructing tissue in larger sections, before it is broken into smaller pieces and suctioned out.
HoLEP is largely prostate size independent, meaning it can be used effectively for both standard and very large prostates, including cases where TURP becomes technically more demanding. Published comparative studies, including several randomised trials, generally show HoLEP achieves strong and durable symptom improvement, with retreatment rates around 6% at five years reported across major analyses. These figures vary between studies depending on patient population and length of follow up, so they should be read as general trends rather than guarantees for any individual patient.
Blood transfusion rates have been reported as lower with HoLEP compared to TURP in several large registry datasets, though this also depends on individual patient factors such as prostate size and use of blood thinning medication.
HoLEP typically requires a catheter for a shorter period than TURP. Most patients are discharged within one to two days.
Dr. I. R. Ravish performs HoLEP at Nephro Uro Clinic. A detailed page specifically about HoLEP surgery in Bangalore is available on this site.
UroLift (Prostatic Urethral Lift)
UroLift is a minimally invasive option for men with BPH who want to avoid tissue removal and preserve sexual function. Small implants are placed through the urethra to hold the enlarged prostate lobes apart, widening the urethral channel without cutting or removing tissue.
UroLift has traditionally been used in men with a prostate volume under approximately 80 mL and limited involvement of the middle part of the prostate, known as the median lobe. Newer techniques and updated guidance have extended candidacy to some patients with median lobe involvement, so this is assessed on a case by case basis rather than ruled out automatically. It is usually performed under local or light sedation, though this depends on the clinical setting, and recovery is generally faster. Retreatment rates over the longer term tend to be higher than with TURP or HoLEP.
It is not suitable for all patients. Candidacy is determined after a proper assessment.
TURP vs HoLEP: Key Differences
| TURP | HoLEP | |
|---|---|---|
| Technique | Electrical resection of prostate tissue | Laser enucleation of prostate tissue |
| Best suited for | Most prostate sizes | Any prostate size, including very large glands |
| Retreatment at 5 years | Around 7 to 8% in published studies | Around 6% in published studies |
| Catheter after surgery | Typically 1 to 2 days | Often shorter than TURP |
| Bleeding and transfusion risk | Generally higher than HoLEP | Generally lower than TURP |
| Sexual function | Retrograde ejaculation common | Retrograde ejaculation common |
| Erectile function | No significant difference reported between the two techniques | No significant difference reported between the two techniques |
These figures come from published studies and can vary depending on the population studied and follow up length, so they should be treated as general guidance rather than an exact prediction for any one patient. Both procedures are safe and effective when performed by an experienced surgeon. The choice between TURP and HoLEP depends on prostate size, the surgeon’s experience, and the patient’s individual circumstances. Dr. Ravish discusses both options at consultation so patients can make an informed choice.
How the Surgery is Performed
All endoscopic prostate procedures at Nephro Uro Clinic are performed under general or spinal anaesthesia. No skin incisions are made.
For TURP, the resectoscope is passed through the urethra and the obstructing prostate tissue is removed in small pieces using an electrical loop. The procedure typically takes 45 to 90 minutes depending on prostate size.
For HoLEP, a Holmium laser fibre is passed through a dedicated endoscopic resectoscope, and the inner obstructing portion of the prostate is separated from its outer capsule before being broken up and removed. Operative time varies with prostate size, anatomy, and surgeon experience.
After the procedure, a catheter is placed to allow the urethra to heal and to drain the bladder. Most patients spend one to two nights in hospital, though this can vary by individual recovery and local practice.
Recovery After Endoscopic Prostate Surgery
Catheter: A catheter is placed at the end of the procedure and remains in for a short period, typically one to three days for most patients, after which it is removed and normal urination is monitored.
At home: Rest is recommended for the first week. Avoid heavy lifting, strenuous activity, and long drives for two to four weeks as advised by your surgeon.
Urinary symptoms in early recovery: Some burning, urgency, and blood tinged urine are common in the first two to four weeks and settle gradually. Staying well hydrated generally helps, unless your doctor has advised fluid restriction for another medical reason.
Return to work: For desk based work, most patients return within two to three weeks. Physical jobs require longer recovery based on the surgeon’s advice.
Intercourse: Timing varies by individual healing, and your surgeon will advise you based on your recovery. Many men are cleared around four to six weeks, but this should be confirmed at your follow up visit rather than assumed.
Follow-up: A urine flow test and review appointment are arranged approximately four to six weeks after surgery to check that healing and urine flow are on track.
Possible Risks and Side Effects
Endoscopic prostate surgery is well established and generally safe. As with any surgical procedure, there are risks, and these are discussed individually with each patient before any decision is made.
Retrograde ejaculation: This is the most common long term effect after both TURP and HoLEP, reported in roughly 70 to 85% of men in major studies, with similar rates seen after HoLEP. Semen travels backward into the bladder during orgasm rather than forward, resulting in what is called a dry orgasm. This does not usually affect the physical sensation of orgasm or erection, though individual experience can vary. It does affect natural fertility, so men who wish to have biological children in the future should discuss this with Dr. Ravish before proceeding.
Erectile dysfunction: Erectile dysfunction caused directly by the surgery itself is uncommon. Published guidance has found no significant difference in erectile function outcomes between TURP and HoLEP. Pre-existing erectile difficulties related to BPH or age may not necessarily change after surgery.
Temporary urinary incontinence: Some men experience leakage or urgency for a period of weeks after surgery while the bladder adjusts. This usually resolves on its own. Persistent leakage beyond three months is uncommon but should be discussed with your surgeon if it occurs.
Urethral stricture: Scar tissue can occasionally form in the urethra after any procedure done through the urethra. This is uncommon and can be treated if it occurs.
Bladder neck contracture: This is a separate, less common late complication where scar tissue narrows the neck of the bladder itself, rather than the urethra. It can occur after either TURP or laser procedures, and is sometimes more likely in smaller prostates. It may cause a return of slow or weak urine flow weeks or months after surgery and is treatable if it happens.
Bleeding: All endoscopic prostate procedures can cause some blood in the urine. Significant bleeding requiring a blood transfusion is reported more often with TURP than with HoLEP in published registry data, though individual risk depends on factors like prostate size and blood thinning medication.
Infection: Urinary tract infection is possible after any bladder or prostate procedure. Your care team will advise on antibiotic use around the time of surgery based on your individual risk and clinical protocol.
When to Contact the Clinic After Surgery
Contact Nephro Uro Clinic promptly if you experience any of the following during recovery:
- Fever above 38°C or chills
- Heavy bleeding with large blood clots in the urine
- Complete inability to urinate after catheter removal, especially with pain or bladder fullness
- Significant worsening of pain not controlled by prescribed medication
- Any other signs of infection, such as worsening urinary symptoms or feeling unwell
Do not wait and see if these symptoms improve on their own. Seek prompt medical attention.
Endoscopic Prostate Surgery at Nephro Uro Clinic, Bengaluru
Dr. I. R. Ravish is a senior urologist with extensive experience in endoscopic prostate surgery. He performs both TURP and HoLEP and selects the most appropriate approach based on each patient’s prostate size, symptom severity, health status, and preferences.
Every patient referred for prostate surgery at Nephro Uro Clinic receives a thorough pre-operative assessment, a clear explanation of all options, and structured post-operative follow-up to monitor recovery and urinary function.
Nephro Uro Clinic is located in Jayanagar, Bengaluru, and is accessible to patients from Tilaknagar, JP Nagar, BTM Layout, Bannerghatta Road, Koramangala, Electronic City, and across the city.
To arrange a consultation for BPH assessment or to discuss endoscopic prostate surgery options, contact the clinic directly.