Removing a large, blocked prostate volume

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Regaining free flight despite a large adenoma

Removal of a large prostatic volume: surgery, HoLEP laser or adenomectomy with Dr. Olivier Dumonceau, urologist in Paris 17th.

Retrait volume prostatique

Introduction

An enlarged prostate gland causes significant compression of the urethra and bladder base, resulting in a mechanical obstruction to urine flow. When medication is no longer sufficient, surgical or endoscopic intervention to remove or unblock the prostate becomes necessary.

It is not just about relieving symptoms: it is often an essential step to preserve bladder function, avoid complications (acute retention, infections, kidney failure) and restore good urinary comfort.

The chosen procedure must be adapted to your anatomy, your general condition, your expectations and the size 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, incomplete or blocked.
  • When the urethra is severely compressed, the bladder struggles to expel urine, which promotes high post-void residual, bladder overload, and even reflux into the upper urinary tract.
  • This type of blockage often requires a true “unblocking” rather than simple medical relief.

Expertise in Laser Enucleation

Expertise Énucléation au laserExpertise Énucléation au laserDr Olivier Dumonceau

Signs and suggestive complications

  • Very weak urinary stream, intermittent or dribbling
  • Difficulty starting or needing to strain to urinate
  • Sensation of incomplete drainage
  • Nocturia (frequent urination at night)
  • Urgent need or urinary urgency
  • Recurrent urinary tract infections
  • Acute retention (complete inability to urinate)
  • Renal failure or impaired renal function secondary to vesicoureteral obstruction

Pre-intervention diagnosis

Before making any decision, a thorough assessment is essential to ensure the suitability of the indication:

  1. Clinical interview and symptom scores (IPSS, impact on quality of life)
  2. Physical examination (digital rectal exam) to assess the size and consistency of the prostate
  3. Urine analysis and blood tests to rule out infection, hematuria, and to assess kidney function
  4. Uroflowmetry/urine flow rate and post-void residual measurement to quantify obstruction
  5. Bladder and prostate ultrasound to measure prostate volume, detect a median lobe, or identify complications
  6. Bladder function/urodynamic assessment in cases of suspected concomitant bladder dysfunction
  7. Assessment of general health, comorbidities, and anticoagulants to evaluate surgical risks

This assessment helps to define the extent of the obstruction, the remaining bladder capacity, and the optimal choice of intervention.

Expertise

What are the side effects of prostate adenoma treatments?

Quels sont les effets secondaires des traitements de l'adénome de prostate ?Quels sont les effets secondaires des traitements de l'adénome de prostate ?Dr Olivier Dumonceau

Techniques for removing the blocking volume

  • Allows for the complete removal of the adenoma, 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 a frequently lower complication rate.
  • A 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.
  • A classic option when the volume is very large or in complex shapes.
  • Requires an incision, longer hospitalization, but allows good control of the obstruction.
  • Laser pulses, vaporization, thermal or steam techniques (e.g., the 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.
  • For prostates exceeding 80 to 100 g, laser enucleation (HoLEP) is often preferred for its tolerability and effectiveness.
  • Open surgery is reserved for extreme cases or when other techniques are not feasible.

Why consult a specialist 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 an informed decision, taking into account your priorities (rapid recovery, minimizing side effects)
  • For rigorous postoperative follow-up, including monitoring, bladder retraining and adjustment if necessary

Experience

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Patient Journey

Let me introduce you to the typical patient journey, my approach to urology, and how I work.

Are you suffering from urinary blockage due to an enlarged prostate?

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FAQ – Frequently Asked Questions

What is meant by a "large prostate volume"?

A normal prostate weighs 20 to 25 grams. A prostate weighing over 80 to 100 grams is considered a large adenoma: at this stage, the obstruction is often significant, and some minimally invasive techniques are no longer effective. The volume is precisely measured by ultrasound or MRI.

What is the best technique for a large adenoma?

Laser enucleation (ThuLEP/HoLEP) has become the standard: it removes the entire adenoma through natural pathways, regardless of its size, with less bleeding and a shorter hospital stay than classic surgical adenomectomy.

What are the risks of not treating a blocking adenoma?

Chronic obstruction can lead to complete urinary retention, infections, bladder stones, and eventually, bladder distension and kidney damage. Treating these complications before they occur preserves bladder function.

Does surgery for a large adenoma protect against prostate cancer?

No. Enucleation removes the adenoma (central area) but leaves the prostatic capsule in place, where cancer can develop. Therefore, PSA monitoring remains necessary after the procedure.

Dr Olivier Dumonceau's expertise

Chirurgien Urologue à Paris

Dr Olivier Dumonceau

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