Transurethral Resection of the Prostate (TURP)
Lithotripsy :: Chemotherapy :: Radiotherapy
Hormone Therapy :: Brachytherapy :: Surgery TURP
The most effective form of treatment for relief of symptoms related to BPH is surgical removal of the central prostatic tissue. This may be viewed as debulking of the prostate – in other words the exterior part of the prostate and it’s capsule are left intact compared with radical prostatectomy performed for cancer where the entire gland is removed. There are several different procedures performed for BPH including TURP, HolEP, BNI and open simple prostatectomy.
Transurethral resection of the prostate (TURP)
Long regarded as the standard treatment for BPH, TURP involves passing a cystoscope with a working electric cutting wire to trim away the central prostatic tissue. The operation is usually performed under spinal anaesthetic and takes around an hour to complete. After removing the tissue, a catheter is placed and irrigating fluid is introduced and drained through this to keep the bladder clear of blood clots. The catheter usually stays in place for 1-3 days and discharge from hospital occurs following removal of the catheter once voiding.
Following surgery there is an increased risk of bleeding for several weeks as the internal wound heals. Because of this risk, it is very important to avoid exertion in the form of sport, gardening, sexual activity or lifting (anything heavier than 5kg). Driving can be resumed at 2 weeks and normal activities at a month. Over this time constipation should be avoided by eating a diet high in fibre and fluid (2L fluid/day) as well as remaining mobile with regular walks. Laxatives may be helpful over this time as well. It is normal to expect urinary urgency, frequency of urination and discomfort on passing urine during the recovery phase.
Although successful at improving symptoms for the majority of men, some risks are associated with TURP. These include bleeding (even the need for blood transfusion for a small number of men), infection (despite routine use of antibiotics at the time of surgery) and temporary changes in the salt and fluid balance. Other uncommon side effects include incontinence (loss of control of the urine with leakage) and problems with erections (up to 10%). A common side effect is retrograde ejaculation (sperm travel backwards into the bladder at orgasm) this is not harmful but may impair fertility (although this cannot be relied upon as contraception).
Holmium laser enucleation of the prostate (HolEP)
HolEP is in many ways similar to TURP in that it is performed using a cystoscope with no external incision required. The point of difference is that this technique uses a laser fibre to dissect the tissue.
Tissue is vapourised at the point of contact with the laser fibre giving a generally less bloody result and avoiding some of the potential problems with salt and fluid imbalance that occur infrequently with TURP. Other risks seen after TURP are basically comparable following HolEP although hospital stay is often shorter. Once prostate fragments have been removed a catheter is placed for irrigation of the bladder. The catheter usually stays in place for 1-2 days and discharge from hospital occurs following removal of the catheter once voiding.
HolEP has largely been developed in New Zealand and is now a well established technique whose effectiveness has been confirmed in many surgical trials.
Bladder Neck Incision (BNI)
Bladder neck incision is performed for bladder neck dysfunction. The bladder “neck” which is found at the junction between the bladder and prostate fails to open appropriately. Men with this condition have often had voiding problems since relatively young and have very little in the way of prostatic growth.
BNI involves dividing the fibres of the bladder neck to improve flow. It can be performed with the same instruments used for either TURP or HolEP. Similar types of risks exist but are less frequently seen. Post-operative care is similar but hospital stay is generally only for 24 hours.
Open Simple Prostatectomy
The open simple prostatectomy involves an incision in the lower abdomen with a similar approach to radical prostatectomy (as performed for prostate cancer). The key difference is that the prostate is opened and the central obstructive tissue removed while leaving the outer shell of the prostate intact. This operation is therefore not a treatment for prostate cancer where the entire prostate is removed.
Although recovery time is similar to radical prostatectomy (i.e. around 6 weeks until fully functioning) the main post operative concerns seen following radical prostatectomy, those of urinary incontinence (leakage) and erectile dysfunction are significantly less frequent.
Open simple prostatectomy is an effective treatment for urinary symptoms due to BPH but takes longer and has a greater risk of bleeding and blood transfusion than TURP or HolEP. It requires hospital admission for 3 to 4 days and catherisation for a week. As such it is reserved for a small subgroup of patients for whom either TURP or HolEP is contraindicated (usually as a result of excessive amounts of prostatic tissue requiring resection).