Transurethral Incision of Prostate (TUIP) or Bladder Neck Incision
(BNI)
TUIP or BNI may be used when the prostate is not too large. Under
anaesthesia, the urologist passes the resectoscope through the
urethra to make two or three small cuts in the neck of the bladder
and partly through the prostate. The long-term advantages of TUIP
over TURP have not been fully evaluated. TUIP appears to carry
less risk of side-effects such as retrograde (reverse) ejaculation
of semen or impotence (also called erectile disfunction), and
is therefore often a preferred surgical option in younger men.
TUIP is most often performed to relieve symptoms of urinary obstruction
when the gland is not particularly large. The long- term results
are similar to a TURP. Hospitalisation is short, usually an overnight
stay.
Open
Prostatectomy
Open prostatectomy is now quite rare, but is used for removing
very large prostates. As with TURP, open prostatectomy will commonly
cause retrograde ejaculation of semen and may also cause impotence.
Most men will regain potency and total urinary control following
this procedure. For an open prostatectomy, access to the prostate
gland is gained through an incision in the lower abdomen. Length
of stay in hospital with open prostatectomies is usually between
4 and 6 days.
Other
Treatment Options for BPE
Generally speaking, a TURP, TUIP or open prostatectomy are the
most effective surgical treatments for reducing symptoms and increasing
flow rate. However there are other, newer ways of reducing the
size of the prostate which are less invasive, may require less
time in hospital and have shorter recovery times, and these are
discussed below. With all treatments, in a small proportion of
men, the prostate tissue will grow back. It is not known yet if
this occurs more often with the newer treatments.
Electrovaporisation
(TVP)
This type of treatment is similar to a TURP in that the obstruction
of the urethra is cleared using an electrical device. With electrovaporisation
the tissue is removed by vaporisation rather than being cut away.
Microwave
Therapy (TUMT)
Microwave therapy is not a common form of treatment for BPE. The
patient receives a local anaesthetic and a device is inserted
into the rectum or the urethra to the level of the prostate gland.
The gland is then heated by microwaves. This causes the gland
to shrink, resulting in a wider urethra, with subsequent lessening
of urinary difficulties. After 3 years, about 50 per cent of men
have an improvement in symptoms and flow rate, however the results
are inferior to a TURP or TUIP.
Laser
Therapy
Laser therapy is also a new form of treatment for BPE. This treatment
uses heat to destroy excess prostatic tissue, thereby relieving
pressure on the urethra to restore a freer flow of urine. Laser
therapy is particularly advantageous as a treatment choice for
men who have a potential bleeding problem due to anti-coagulant
medications, warfarin and aspirin, and in those men with significant
heart disease. Results for one of the more common forms of laser
therapy showed that symptoms decreased by 50 per cent and flow
rate increased by 60 per cent after one year. The Holmium laser
appears to be the most effective laser system for relieving obstruction.
Radiofrequency
Needle Ablation (TUNA)
This method uses radiofrequency energy to heat the tissue. A special
cystoscope is inserted into the urethra, and small needles inserted
into the prostate, which emit the radiowaves. This is a quick
procedure, and doesn't require an anaesthetic or admission to
hospital. Symptoms are reduced by about 50 per cent after one
year and there are very few side-effects. As with the other new
methods, it is not known how long the relief from symptoms lasts.
