Treatment Options


TURP

Transurethral resection of the prostate (TURP) is an established operation to treat blockage of bladder emptying due to BPH. It can be performed under a general or spinal anaesthetic. An instrument on the end of a telescope passed down the water pipe removes up to half of the prostate from the inside, relieving obstruction caused by prostatic enlargement. The patient stays in hospital for two or three days.

Risks that many patients may be concerned about include sexual problems and incontinence. In considering risks and potential problems after the procedure, it is important not to confuse this operation with radical prostatectomy (RP) which can be an open, laparoscopic or robotic procedure. This is a very different operation which involves removing the whole prostate and some of the surrounding tissue to treat prostate cancer. In TURP, for men with previously good sexual function, problems with erections can occur in 10 to 20%, and retrograde ejaculation (dry ejaculation) occurs in 80%, but incontinence is very rare. In RP, all men have dry ejaculation, most have some degree of erectile dysfunction and around 10% have persistent troublesome urinary leakage.

TURP remains the standard operation against which other procedures for BPH must be compared and judged. Over the years, many alternatives to TURP have come and gone, including microwave treatment, cryosurgery, and a variety of different laser operations. Problems have included persistent discomfort on passing urine, higher rates of incontinence, inadequate relief of symptoms or short duration of effect.

TURis (bipolar TURP)

The TURis system (transurethral resection in saline) has been developed by Olympus. In many respects, it is not a new operation, but rather an optimisation of all aspects of TURP. The major difference is that the electrical current used to cut prostate tissue is delivered through a bipolar system (rather than monopolar used in conventional TURP) so saline irrigation fluid can be used to flush into and out of the bladder during the operation (rather than glycine in TURP) so that very little extra fluid is absorbed into the body, reducing the risk of serious complications such as TUR syndrome almost to zero. The system has been in use for over a decade and has been approved by the National Institute for Health and Care Excellence (NICE):

Click here for link to NICE Website

There is less blood loss during and after the operation. It is safe to continue the procedure for much longer than a TURP, so larger prostates can be satisfactorily treated and a larger amount of prostate tissue can be removed. This means that TURis is as effective as the latest generation of laser prostate operations at treating larger prostates but with a lower risk of incontinence.

Summary of TURis:
- Bipolar energy
  • - Saline irrigation fluid
  • - Less blood loss
  • - Shorter time with catheter afterwards
  • - Suitable for large prostates but lower incontinence rate than laser surgery

www.olympus.co.uk/medical/en/Products-and-solutions/Products/Urology/Advanced-Bipolar-Energy.html

UroLift (prostatic urethral lift)

UroLift is also a minimally invasive procedure to treat obstruction due to BPH in men with small- to medium-sized prostates. It involves placement of 2 to 6 (usually 4) small clips to lift the lobes of the prostate aside to relieve blockage. It has been approved by the National Institiute for Health and Care Excellence (NICE):

Click here for link to NICE Website

It is done under a short general anaesthetic and patients go home the same day without the need for a catheter. The chance of it affecting erections or ejaculation is extremely low.

Enlarged Prostate - An enlarged prostate can narrow or even block the urethra.
Step 1 - The UroLift Delivery Device is placed through the obstructed urethra to access the enlarged prostate.
Step 2 - Small UroLift Implants are permanently placed to lift or hold the enlarged prostate tissue out of the way and increase the opening of the urethra. The permanent Implants are delivered through a small needle that comes out of the UroLift Delivery Device and into the prostate.
Step 3 - The UroLift Delivery Device is removed, leaving an open urethra designed to provide symptom relief.

It may be suitable for men whose symptoms are well controlled with medication but would prefer not to have the dry ejaculation that alpha-blockers can cause and would prefer not to take a tablet every day. Also, men may prefer this procedure as it has a shorter recovery time and no requirement for a catheter afterwards

Summary of UroLift:
- Day case procedure
  • - No catheter afterwards
  • - Shorter recovery time
  • - No effect on erections or ejaculation
  • - Suitable for small- to medium-sized prostates

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Prostate Artery Embolisation (PAE)

This is a sophisticated new technique involving precisely blocking small blood vessels to the prostate under X-ray guidance. The prostate subsequently shrinks and blockage is relieved. It is associated with few side effects and a quick recovery time. It is suitable for a particular group of men who accept that it may not be as effective in improving symptoms as other procedures and its effect may not last as long.