Prostate Health
Performed by Dr. David Wetherell
Prostate health conditions can affect urinary function and quality of life. This page outlines the key prostate procedures offered by Dr David Wetherell, with clear information about what each procedure involves and what to expect before and after treatment.
Transperineal Prostate Biopsy
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Transurethral Resection of the Prostate (TURP)
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Laser Surgery for Prostate - HoLEP & ThuLEP
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Minimally Invasive Surgical Treatment (MIST) for Prostate Enlargement
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Transperineal Prostate Biopsy • Transurethral Resection of the Prostate (TURP) • Laser Surgery for Prostate - HoLEP & ThuLEP • Minimally Invasive Surgical Treatment (MIST) for Prostate Enlargement •
Transperineal Prostate Biopsy
The Key Things to Know:
A transperineal prostate biopsy is a minimally invasive procedure used to sample tissue from the prostate gland. It is performed through the skin between the scrotum and anus using fine needles guided by ultrasound. This approach offers improved accuracy and a lower risk of infection compared to older transrectal techniques.
What It Is
This procedure involves using ultrasound guidance to insert biopsy needles through the perineal skin (between the scrotum and anus) into the prostate to obtain small tissue samples. These samples are analysed under a microscope to check for prostate cancer or other abnormalities. The test is usually performed as a day procedure under general anaesthetic.
When It's Needed
Your urologist may recommend a transperineal prostate biopsy if: - Your PSA blood test is elevated or rising over time - An MRI scan of the prostate shows a suspicious area - There are abnormal findings on rectal examination - You require repeat testing after an inconclusive or negative biopsy but ongoing concern remains
Surgery Diagram
Benefits
Increased accuracy in detecting clinically significant prostate cancer
Reduced risk of infection
because the needles do not pass through the bowel
Suitable for both targeted (MRI fusion)
and systematic sampling
Usually performed as a same-day procedure with quick recovery
Risks
Although generally safe, all procedures carry some risks:
Temporary blood in the urine, semen, or stool for a few days
Mild perineal bruising or discomfort
Urinary retention (difficulty passing urine) in a small number of cases
- Infection risk is very low but can occur; antibiotics are usually given before the procedure
Rarely, temporary difficulty with urination may require a short-term catheter
What to Expect After the Procedure
You’ll usually go home the same day once you can pass urine. Mild discomfort or stinging is common and improves over a few days. You may notice some blood in urine or semen for up to 4-6 weeks - this is normal. Avoid strenuous exercise for 48 hours and drink plenty of water. Most men return to normal activities within a day or two. Biopsy results are generally available within one to two weeks, and we will discuss them at follow-up.
FAQs
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Yes. Transperineal biopsy uses a skin approach rather than through the rectum, which significantly lowers infection risk.
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Local anaesthetic and sedation make it very tolerable. Most patients describe only mild discomfort.
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Antibiotics are given at the time of the biopsy only. Normally, a longer course of anti-biotics are not required.
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If you had sedation, you’ll need someone to drive you home. If local anaesthetic only, you can usually drive yourself.
Transurethral Resection of the Prostate (TURP)
The Key Things to Know:
Transurethral Resection of the Prostate (TURP) is a common operation to treat urinary symptoms caused by an enlarged prostate (benign prostatic hyperplasia or BPH). It remains the traditional ‘gold standard’ procedure for moderate to large prostates, offering durable results and excellent symptom relief.
What It Is
TURP is a minimally invasive surgical procedure performed under spinal or general anaesthetic. A small telescope (resectoscope) is inserted through the penis into the bladder. Using an electric loop, small chips of prostate tissue are removed to relieve the obstruction and improve urine flow. The operation does not involve any external cuts.
When It's Needed
TURP is recommended if you have:
Difficulty passing urine or a weak stream
Frequent urination, especially at night
Incomplete bladder emptying
Recurrent urinary infections or bladder stones due to obstruction
Urinary retention (inability to pass urine)
Bleeding from the prostate (haematuria)
Surgery Diagram
Benefits
Proven long-term results with strong evidence for symptom improvement
High success rate with significant improvement in urine flow
Minimally invasive and widely available
Most men experience quick relief and improved quality of life
Risks
All operations carry some risks, including:
Temporary burning or frequency when passing urine
Blood in the urine for several days after surgery
Retrograde ejaculation (semen flows backwards into the bladder) occurs in up to 70% of men
Urinary tract infection (1-3%)
Temporary catheter after surgery (usually for 1-2 days)
Rarely, bleeding requiring return to theatre or a longer hospital stay
What to Expect After Surgery
You’ll usually stay in hospital overnight with a catheter to help the bladder drain. Irrigation fluid may run through the catheter to prevent clots. Once urine clears, the catheter is removed, usually within 1-2 days. Mild stinging, urgency, or frequency is common for a few weeks. You should avoid heavy lifting or strenuous activity for 2-3 weeks. Most men notice a marked improvement in urinary flow within days, with full recovery over 6-8 weeks.
FAQs
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Erections are usually unaffected, but ejaculation is often retrograde (dry orgasm).
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TURP provides long-term relief, although a small percentage of men may need further treatment after 10-15 years
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Most men no longer need prostate medication after surgery.
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Light activities are fine within a week; office work after 1-2 weeks. Avoid strenuous exercise or heavy lifting for 3-4 weeks.
Laser Surgery for Prostate - HoLEP & ThuLEP
The Key Things to Know:
Laser enucleation of the prostate (HoLEP or ThuLEP) uses high-energy laser technology to remove obstructing prostate tissue. It achieves equivalent symptom relief to TURP but with less bleeding, faster recovery, and suitability for large prostates. Both procedures are strongly recommended by the 2025 EAU guidelines for benign prostate obstruction.
What It Is
Holmium (HoLEP) and Thulium (ThuLEP) laser enucleation remove the inner prostate tissue that causes blockage. Using a laser through a telescope, the enlarged tissue is carefully dissected away in its natural plane and then removed (morcellated) from the bladder. No cuts are made externally.
When It's Needed
Laser prostate surgery may be recommended if you have:
Significant urinary symptoms due to an enlarged prostate
Recurrent urinary retention or catheter dependence
Bladder stones or infections related to poor flow
Very large prostate where TURP may be less suitable
Surgery Diagram
Benefits
Minimally invasive with short catheter and hospital time
Works for all prostate sizes (‘size independent’)
Less bleeding and transfusion risk compared to TURP
Durable results comparable to open surgery
Low risk of recurrence or need for repeat treatment
Risks
As with any procedure, risks exist:
Temporary burning or urgency after surgery
Blood in urine for several days
Transient leakage (stress incontinence) in the first few weeks
Retrograde ejaculation in most men
Rarely, infection, bleeding, or urethral stricture
What to Expect After Surgery
Most men stay one night in hospital. The catheter is usually removed within 24 hours, and urine flow improvement is often immediate. Light activity can resume within days, but avoid strenuous exercise for 2 weeks. Mild leakage or urgency can occur but typically resolves as the pelvic floor recovers. Sexual function (erection) is usually unchanged, although ejaculation may change.
FAQs
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Both are effective. Laser surgery often has a quicker recovery and less bleeding
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Holmium or Thulium lasers; both have equivalent outcomes.
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Temporary leakage can occur in the first few weeks and is managed with pelvic floor exercises.
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Yes, laser enucleation is effective even for very large prostates (>100 g).
Minimally Invasive Surgical Treatment (MIST) for Prostate Enlargement
The Key Things to Know:
Minimally Invasive Surgical Treatments (MIST) are alternatives to traditional prostate surgery for men with urinary symptoms due to benign prostatic hyperplasia (BPH). They aim to improve urine flow while reducing hospital stay, recovery time, and side effects.
What It Is
MIST procedures use various technologies such as steam (Rez■m), waterjet (Aquablation), or prostatic urethral lift implants (UroLift) to open the prostate channel without removing large amounts of tissue. These procedures are usually performed as day cases under local or light general anaesthetic.
When It's Needed
MIST may be recommended if you have bothersome urinary symptoms (frequency, urgency, weakflow, or nocturia) due to BPH and prefer a less invasive treatment with a lower risk of sexual side effects. It is suitable for small to moderate prostate sizes without significant middle lobe obstruction.
Surgery Diagram
Benefits
Short hospital stay (often same day)
Quick recovery and minimal bleeding
Reduced risk of retrograde ejaculation compared to TURP
Rapid improvement in urinary symptoms
Some options can be done under local anaesthetic
Risks
Temporary urinary frequency, urgency, or burning
Blood in urine for several days
May require a catheter for 1-3 days
Small risk of needing further surgery over time
Rare infection or urinary retention
What to Expect After Surgery
Most patients go home the same day. You may notice mild discomfort, urgency, or frequency that improves within days to weeks. Drink plenty of fluids and avoid heavy exercise for about a week. Symptom improvement is usually noticeable within 4-6 weeks.
FAQs
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Choice depends on prostate size, anatomy, and patient priorities (sexual function, recovery time, durability).
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Some men can stop medication, though others may continue if symptoms persist.
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MIST options can be effective for several years, though re-treatment rates are higher than TURP or HoLEP.
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