Removing a large volume of blocking prostate tissue
Introduction
A large prostatic blockage results in significant compression of the urethra and bladder base, causing mechanical obstruction to urine flow. When drug treatments are no longer sufficient, it becomes necessary to consider surgical or endoscopic intervention to remove or unblock the prostate .
It is not just about relieving symptoms: it is often an essential act to preserve bladder function, avoid complications (acute retention, infections, renal failure) and restore good urinary comfort.
The chosen procedure must be adapted to your anatomy, your general condition, your expectations and the volume of the prostate.
What is meant by “large blocking prostate volume”?
- We are talking about a large prostate volume (often > 80–100 g) accompanied by severe symptoms of urinary discomfort or complications.
- This volume causes an obstruction of the urinary tract: the passage of water is slowed down, incomplete or blocked.
- When the urethra is severely compressed, the bladder struggles to expel urine, which promotes high post-void residual urine, bladder overload, and even reflux into the upper urinary tract.
- This type of blockage often requires actual “clearing” rather than just drug relief.
Laser enucleation (HOLEP)
Suggestive signs and complications
The following symptoms or signs should alert you:
- Very weak, intermittent, or dribbling urine stream
- Difficulty starting or needing to push to urinate
- Feeling of incomplete emptying
- Nocturia (frequent urination at night)
- Urgent need or urgency to urinate
- Recurrent urinary tract infections
- Acute retention (complete inability to urinate)
- Renal failure or impaired renal function secondary to vesicoureteral obstruction
When there is a risk to the kidneys or risk of irreversible bladder damage , urgent action is needed.
Diagnosis prior to intervention
Before any decision, a rigorous assessment is essential to secure the indication:
- Clinical interview and symptom scores (IPSS, impact on quality of life)
- Physical examination (digital rectal exam) to estimate the size and consistency of the prostate
- Urine analysis and biological assessment to rule out infection, hematuria, and assess renal function
- Uroflowmetry/Urine flow rate and post-void residual measurement to quantify obstruction
- Bladder-prostatic ultrasound to measure prostate volume, detect a median lobe or complications
- Assessment of bladder function/urodynamics in cases of suspected concomitant bladder dysfunction
- Assessment of general condition, comorbidities, anticoagulants to assess operative risks
This assessment makes it possible to define the extent of the obstruction, the remaining bladder capacity, and the optimal choice of intervention.
Techniques for removing blocking volume
Depending on the volume, anatomy, risks and surgical expertise, several techniques can be considered:
Laser enucleation of the prostate (HoLEP)
- Allows the complete adenoma to be removed, without strict volume limits.
- It is a reference technique for large prostates: effectiveness, reasonable operating time, good hemostatic control.
- Results comparable to open surgery, with often a lower complication profile.
Transurethral resection (TURP)
- Well-established technique for moderate volumes, but limited in cases of very large prostates.
- Higher risk of bleeding or incomplete resection if the volume is too large.
“Open” or suprapubic adenomectomy
- Classic option when the volume is very large or in complex shapes.
- Requires an incision, longer hospitalization, but allows good control of the obstruction.
Minimally invasive hybrid or alternative techniques
- Laser pulsation, vaporization, thermal techniques or steam (e.g. REZUM technique) to reduce prostate volume in a less invasive way.
- Useful when the volume to be removed is moderate or as a complement depending on the anatomy.
Choice of gesture depending on the volume
- For prostates exceeding 80 to 100 g, laser enucleation (HoLEP) is often preferred for its tolerance and effectiveness.
- Open surgery is reserved for extreme cases or when other techniques are not feasible.
Expected benefits and limitations
Benefits
- Long-lasting relief from urinary obstruction
- Significant improvement in urinary flow
- Reduction of bladder residual
- Disappearance or reduction of recurrent urinary tract infections
- Preservation/recovery of bladder and kidney function
Limits and risks
- Risk of bleeding, requiring postoperative monitoring
- Risk of urinary complications (temporary retention, clots, stenosis)
- Possible side effects: anejaculation, transient discomfort, temporary bladder problems
- Some techniques have limitations depending on the anatomy (large median lobe, calcifications)
- The patient's general condition and comorbidities may influence the choice and success
Why consult a specialized urologist?
- To accurately assess bladder obstruction, volume and function
- To offer the best surgical technique suited to your case
- To anticipate risks, optimize preparation and monitoring
- To help you make informed decisions, taking into account your priorities (rapid recovery, minimization of side effects)
- For rigorous post-operative follow-up, including monitoring, bladder rehabilitation and adjustment if necessary
Dr. Olivier Dumonceau offers a personalized, modern and attentive approach at each stage.
Side effects of prostate treatments
Do you suspect a prostate adenoma?
Requirements
- Prostate surveillance after age 50
- Prostate cancer screening
- REZUM (steam thermotherapy)
- UroLift (trans-urethral implants)
- Holmium laser / ThuLEP
- Robotic-assisted radical prostatectomy
Patient pathway
Let me introduce you to the classic patient journey, my approach to urology and the way I work.
Are you suffering from urinary blockage due to a large prostate?
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