What Is Minimally Invasive Prostate Resection?
You may suffer from problems with urination, such as a frequent and urgent need to urinate. You may get up often at night to urinate or have a very slow flow of urine. If so, you may have a condition called benign prostate hypertrophy (BPH), or an enlarged prostate gland. Symptoms occur when the extra tissue of your enlarged prostate interferes with your urethra (the tube that moves urine from the bladder to the penis).
To help reduce your symptoms, your doctor can perform a minimally invasive prostate resection. This means surgery to remove part of the prostate gland. A minimally invasive procedure does not involve cutting open your skin and can sometimes be done in your doctor’s office.
Why Is a Minimally Invasive Prostate Resection Done?
An enlarged prostate gland can result in problems with urination that are very inconvenient. Pressure on your urethra may make you feel like you have to urinate often, and you might feel as though you cannot fully empty your bladder. You may also have bladder stones or frequent infections.
If making changes to diet and drinking patterns and taking medications don’t relieve symptoms, your doctor may recommend surgery.
A prostate resection to remove part of the gland can be done with a surgical incision (simple prostatectomy or open prostate resection) or with one of several minimally invasive procedures. Because these procedures do not require the surgeon to cut into your body, there is less risk of complications and less recovery time after the procedure. Often, they are done as outpatient procedures, and you can recover at home.
These less invasive treatments include:
- transurethral resection of the prostate (TURP)
- transurethral needle ablation (TUNA)
- transurethral microwave therapy (TUMT)
- transurethral incision of the prostate (TUIP)
- transurethral electrovaporization (TUVP)
- photoselective vaporization of the prostate (PVP)
- laser prostatectomy or holmium laser enucleation of the prostate (HoLEP)
How Is a Minimally Invasive Prostate Resection Performed?
All minimally invasive prostate treatments are performed by inserting an instrument into the opening of the penis and pushing it up through the urethra to access the prostate gland. This prevents cutting into your body, and it’s where the term “transurethral” comes from.
You will receive some type of anesthesia for this procedure to reduce or eliminate pain. Local anesthesia (when anesthetic is applied only to the area of the body being worked on) and sedation may be used. Spinal or epidural anesthesia, in which sensation is blocked from the waist down, is also used. In some cases, general anesthesia, when you are asleep for the whole treatment, is given.
Transurethral Resection of the Prostate (TURP)
TURP involves using a small electric cutting tool at the end of a special instrument (cystoscope) to cut out the excess prostate tissue. Surgery takes 60 to 90 minutes. General or epidural anesthesia is used, and the treatment is done at a surgical center or hospital.
After the treatment, you will remain in the hospital for one to three days. A Foley catheter will remain in your urethra for a few days to help urine drain. This is the oldest of the minimally invasive treatments. Its results last longer than those of other treatments, though there may be more complications.
Transurethral Needle Ablation (TUNA)
TUNA involves the destruction of part of the prostate with heat made by low-energy radio waves. Your doctor pushes small needles into the prostate with the cystoscope. Then radio waves pass through the needles to heat them, and the excess prostate tissue is destroyed.
This treatment is usually done in a doctor’s office or outpatient clinic with a local anesthetic (injected through the penis or the rectum) and a sedative (you will need someone to drive you home). Sometimes, an epidural or general anesthesia may be used. This treatment takes less than an hour.
You will have a catheter in place for several days after the treatment.
Transurethral Microwave Therapy (TUMT)
TUMT uses a tiny microwave antenna attached to a catheter tube. The catheter is put into the tip of your penis and then pushed up the urethra into the prostate. The microwave antenna creates heat that can destroy a small area of the prostate and relieve pressure on the urethra. Water circulating around the antenna protects the urethra.
This is usually done with a local anesthetic and intravenous (IV) sedation. You will have a Foley catheter in place for several days to allow urine to drain.
Transurethral Incision of the Prostate (TUIP)
TUIP is a technique in which an instrument called a resectoscope is put into the urethra. A tiny slicing tool at the end of the device is used to make cuts into the extra prostate tissue. This relieves the pressure on the urethra and reduces urinary symptoms. The process takes 20 to 30 minutes but requires epidural or general anesthesia.
You may be allowed to leave the hospital or surgical center on the same day. If there are any complications, you may have to stay overnight. You will have a Foley catheter in place for several days to allow you to drain urine.
Electrical and Laser Treatments
Transurethral electrovaporization of the prostate (TUVP) uses electrodes attached to a resectoscope to vaporize (destroy) extra prostate tissue. A cystoscope and a laser achieve the same results in photosensitive vaporization of the prostate (PVP). With Holmium laser enucleation of the prostate (HoLEP), a laser attached to a resectoscope carves away parts of the prostate. These parts can then be examined to check for the presence of cancer cells.
These methods require anesthesia and can be done in a surgical clinic, but often a one-to-two-day stay in the hospital is still needed. Again, you will have a Foley catheter in the urethra to allow urine to drain, but you may be able to return home without it.
There is less risk of bleeding from these procedures than with the other minimally invasive options because the energy used in the procedures seals the surrounding blood vessels. However, there are still potential complications.
How Do I Prepare for a Minimally Invasive Prostate Resection?
Your doctor will work with you to determine whether surgery is the best option to treat your symptoms and if you are healthy enough for the procedure. You will have a complete physical exam, and your doctor will ask if you are being treated for any other medical conditions, such as high blood pressure, diabetes, or asthma. If you smoke, you should try to stop several weeks before surgery.
You doctor may order an imaging procedure to look at the area of the prostate that needs to be removed. This is done with a cystoscope inserted through the penis and into the urethra, usually with local anesthesia and sedation. These images may help your doctor determine which type of surgery is your best option.
Make sure to tell your doctors and nurses which drugs and vitamins you take, especially any medicines that might thin your blood. These may cause complications and excessive bleeding during surgery. Problematic drugs and vitamins may include warfarin (Coumadin), clopidogrel (Plavix), aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), and vitamin E. You might need to stop taking certain medications weeks before surgery.
Make sure that you do not eat or drink in the hours before your surgery. Nausea and vomiting from anesthesia can occur and lengthen your stay in the hospital.
What Will Happen After My Minimally Invasive Prostate Resection?
After treatment, you may need to stay in the hospital. Even if you are discharged to go home right after the procedure, you will need to stay in bed and rest. However, after a day of rest, try to move around as much as possible to prevent blood clots. You may need to wear special socks to prevent blood clots in your legs or a breathing device to keep your lungs healthy.
It is important to take care of the catheter that allows urine to drain from your bladder. You should not exercise vigorously or lift heavy objects. The amount of time you will need to wear the catheter depends on your procedure and the size of your prostate. Men with larger prostates might require a catheter for longer. You may be able to remove your catheter at home. In some cases, your doctor will want you to have it removed at an office visit.
Temporary post-surgery symptoms may include:
- blood in your urine
- a mild burning sensation when you urinate
- a sudden, urgent need to urinate
- a need to urinate often
These should resolve in a few days or a few weeks as you heal. However, you might not notice improvement in the symptoms that prompted your surgery for a month or more.
What Are the Risks of Minimally Invasive Prostate Resection?
All of these procedures are surgical, and all carry risks. However, the risks are less than those of an open prostatectomy.
All surgery has the potential to cause rare complications, including blood clots in the legs, breathing problems, reactions to anesthesia, excessive bleeding, infection, heart attack, and stroke. Your doctor and care team will work hard to prevent any of these problems.
Complications specific to prostate surgery can include:
- transurethral resection (TUR) syndrome (water buildup when the body absorbs fluids used during surgery)
- urinary incontinence (problems with controlling the urge to urinate)
- urethral stricture (scar tissue blocking part of the urethra)
- problems maintaining an erection (impotence)
- semen moving into the bladder rather than out of the penis (retrograde ejaculation)
- damage to internal organs
Take to your doctor about these risks. Each treatment carries different levels of risk and has different advantages.
What Can Be Expected in the Long Term?
All of these treatments should relieve your urinary symptoms. But you may need to have the treatment done again after five years. The effects of the TURP procedure, which is the most invasive, seem to last the longest at five to 10 years.
The other, less invasive procedures may have fewer urinary and sexual complications, but you have a higher chance of needing repeat surgery with these treatments, according to the National Institutes of Health (NIH).
You need to talk with your doctor to determine which procedure is best for you.
Make sure you continue to have regular rectal prostate exams to check for changes in your prostate gland.