Alok Anand MD

The Common Vein Copyright 2010

Introduction

There are 3 main surgical options for treatment of BPH: 1) transurethral resection of the prostate (TURP), 2) transurethral incision of the prostate (TUIP), and 3) open prostatectomy.

TURP:

This is the gold standard for effective treatment for BPH. The procedure is performed using a scope designed to pass through the urethra and allow a wire loop with electrical current to remove chips of prostatic tissue. Patients usually require an overnight stay in the hospital. Major complications of this procedure are bleeding, hyponatremia from absorption of free water, incontinence, and retrograde ejaculation. Operative time is generally limited to 1 hour in order to prevent hyponatremia.

TUIP

TUIP is similar to TURP. However, instead of removing prostatic tissue, an electrical knife is used to make small cuts in the prostate.

Open Prostatectomy

Open prostatectomy can be performed for extremely large prostates either through a suprapubic or perineal approach. This is a more invasive procedure with higher complications include bleeding and infection.

Other Minimally Invasive Procedures

Other minimally invasive procedures include: 1) laser prostatectomy, 2) transurethral microwave thermotherapy (TUMT), high intensitry focused ultrasound (HIFU), transurethral needle ablation (TUNA), prostatic stents, and transurethral electrovaporization.=

Laser Prostatectomy:

This technique utilizes a laser with various wavelengths. There is a decreased risk of bleeding, fluid absorption, retrograde ejaculation, impotence, and incontinence. Patients usually require a shorter hospitalization and sometimes can be done as an outpatient. performed with the use of a laser with various types and wavelengths have the advantages of lack or decreased risk of complications such as intraoperative bleeding and fluid absorption, retrograde ejaculation, impotence, and incontinence. Patients undergoing this procedure tend to require shorter hospital stays and can be admitted on an outpatient basis.

TUMT:

This technique uses microwave energy with frequencies between 915-2450 MHz to heat tissues. This procedure can be done as an outpatient with local anesthesia. It is safer than a TURP but not as effective.

HIFU:

HIFU uses ultrasonic energy to heat the prostate. This is done transrectally.

TUNA:

TUNA uses high-frequency radio wave to cause thermal injury to the prostate. Needles are inserted into the prostate and energy is delivered through them to localized areas. The procedure only requires local anesthesia.

Prostatic stents:

These are permanent, flexible, expanding devices placed in the urethra to expand the lumen. Advantages of this procedure include: short operative time, minimal bleeding, no need for post-operative catheter, and no need for a hospital stay.

Transurethral electovaporization:

This technique simultaneously vaporizes and coagulated prostatic tissue so no bleeding or fluid absorption occurs. Operative times can be much longer than an hour, therefore much larger glands can be operated on.