As of: February 4, 2024, 8:00 a.m
By: Andreas Beez
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King Charles has benign prostate enlargement - like most men his age.
An experienced urology chief explains the operation.
Hardly any man is immune from this widespread disease; it affects crowned heads such as the English King Charles as well as the master craftsman Heinrich Mutz from Lower Bavaria: As men get older, most of them develop problems with their prostate.
Up to 80 percent of people over 60 have to struggle with an enlarged prostate.
Medication often helps at first, but sooner or later many patients can no longer avoid surgery.
“Of course no one likes to go under the knife,” says Professor Christian Stief, Director of Urology at the LMU Clinic.
“But the understandable fear of this procedure is now really unfounded.
Thanks to enormous advances in medicine, it is now extremely gentle and very safe.
We can give patients a lot of quality of life back with minimal surgical risk.”
King Charles III
with wife Camilla.
A head of urology explains King Charles' operation.
© Chris Emil Janssen/IMAGO
What the PSA value says about possible prostate diseases
But how do you differentiate between benign prostate enlargement and prostate cancer?
The PSA value, which is determined in the laboratory after a blood sample, provides an important clue.
There is a rule of thumb among urologists: divide the volume of the prostate by 20; the PSA value should not be higher than the result.
An example: If the prostate measures 40 millimeters, then a PSA value of up to 2 is in the green range.
However, if the PSA value is 4, it is considered abnormal.
In this case, the urologist asks his patient whether he recently felt sick, such as burning when urinating or severe abdominal pain.
The reason: An inflammation of the prostate or a urinary tract infection could have caused the PSA level to rise.
However, a cancerous tumor cannot be ruled out as a trigger.
“Therefore, if in doubt, you should examine the prostate more closely with magnetic resonance imaging,” advises Professor Christian Stief, Director of the Urology Clinic at the LMU Clinic.
The prostate specialists at the LMU Clinic and their laser (from left): Dr.
Patrick Keller, Prof. Christian Stief and private lecturer Dr.
Philipp Weinhold.
© LMU Clinic
Professor Christian Stief: Prostate starts to grow from around the age of 35
“Until around the age of 35, the size of the prostate hardly changes; it is around 20 milliliters.
“It then begins to grow continuously, although the speed depends on hereditary predisposition,” explains Stief.
The tissue growth can become so large that the prostate restricts the urethra and at the same time presses on the urinary bladder.
On the one hand, this irritates the urinary bladder and those affected often have to go to the toilet.
On the other hand, it is more difficult for them to urinate because the urine has difficulty draining away.
“Many patients have problems, especially in the morning or at night.
They have to go out often and really push hard to empty their bladder,” explains Stief.
Prostate patients often have problems urinating
An enlarged prostate can be examined relatively easily.
To do this, the urologist holds an ultrasound probe on the abdominal wall.
With the device he can, among other things, determine the volume or size of the prostate and determine whether there is still urine in the bladder, so-called residual urine.
“Residual urine forms when the bladder can no longer overcome the narrowing of the urethra.
This is a sign of beginning decompensation of the urinary bladder.
In practice it often looks like this: the patient goes to the toilet every ten minutes, but never has the feeling that his bladder is really empty afterwards.
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Such symptoms should not be taken lightly, warns Stief.
“If you don't do anything about it and the enlargement continues to grow, urine can build up not only in the bladder, but all the way up into the kidneys.
These can cause irreparable damage.
Unlike the liver, the kidneys cannot regenerate.”
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Prostate enlargement is often initially treatable with medication
In many cases, an enlarged prostate can initially be kept under control with medication.
There are, among other things, remedies that relax the prostate and thereby expand the urethra again.
This allows patients to urinate better again.
Other preparations block the so-called stretch receptors in the urinary bladder - with the effect that you no longer have to go to the toilet as often.
A third type of tablet even causes the prostate to shrink.
“All of these medications have been well researched and have been available for decades.
“They are well tolerated and very rarely cause side effects – neither shortly after taking them nor after many years,” analyzes Stief.
“There are only a few reasons not to prescribe them, for example if the patient also suffers from Parkinson's disease.
You have to choose other means for them.”
Urology professor: Surgery for an enlarged prostate is much gentler today than it used to be
The medication usually works well.
But their effect eventually wears off.
“Experience shows that they no longer help after about five to seven years,” says Stief.
Then an operation is scheduled.
However, it has lost much of its horror and is now considered a routine procedure in large centers.
While 20 years ago it was a procedure that involved a lot of bleeding and was quite prone to complications, today specialists can remove the enlargement in a minimally invasive manner - without a single external incision.
Instead, they insert a delicate instrument through the urethra.
“We use either a tiny laser or a bipolar loop that uses electricity to cut,” Stief explains.
“The excess tissue is first carefully loosened and then sucked out.
Afterwards, to be on the safe side, the laboratory examines whether it was actually benign tissue and not a carcinoma.”
The procedure for enlarged prostate takes about 40 to 60 minutes
During the procedure, the surgeon removes the tissue from the inside.
“As a layperson, you can imagine the procedure as hollowing out an organ.
You get the pulp out without damaging the peel.
This puts you at a safe distance from sensitive nerves on the outer shell of the prostate and the bladder sphincter.
Sexual function is not affected and incontinence is extremely rare.” Nowadays, patients with extremely enlarged prostates can also be safely operated on using this technique.
The procedure takes around 40 to 60 minutes under general anesthesia.
Afterwards, patients only have to stay in the clinic for a few days.
The effect of the operation lasts a long time.
After treatment with the bipolar sling, patients usually no longer have any problems with their prostate for 15 years; after laser enucleation, as the technical term goes, they are even calm for around 25 years.
Professor Christian Stief advises: Find out about the clinic before treatment
Prof. Christian Stief Urologist © Klaus Haag
Although this is a routine procedure, you should find out more about the clinic beforehand - for example on the Internet at www.weisse-liste.de or in the AOK hospital guide.
There, patients learn, among other things, how often benign prostate enlargements are operated on in the house.
“The number of cases is an important criterion.
If a clinic carries out several hundred such procedures per year, it has the necessary experience and usually has a lower complication rate than hospitals with only a few operations,” says Stief.
At the LMU Clinic, for example, 800 patients with benign prostate enlargements are operated on every year.