Definition

Minimally invasive prostate resection is surgery to remove part of the prostate gland, to treat an enlarged prostate. The surgery will improve the flow of urine through the urethra, the tube that carries urine from the bladder outside of your body. It can be done in different ways. There is no incision (cut) in your skin.

Alternative Names

Laser prostatectomy; Transurethral needle ablation; TUNA; Transurethral incision; TUIP; Holmium laser enucleation of the prostate; HoLep; Interstitial laser coagulation; ILC; Photoselective vaporization of the prostate; PVP; Transurethral electrovaporization; TUVP; Transurethral microwave thermotherapy; TUMT; TURP- transurethral resection of prostate

Description

These procedures are often done in your doctor's office or at an outpatient surgery center.

The surgery can be done in many ways. The type of surgery will depend on the size of your prostate and what caused it to grow. Your surgeon will consider the size of your prostate, how healthy you are, and what type of surgery you may want.

All of these procedures are done by passing an instrument through the opening in your penis (meatus). You will be given general anesthesia (asleep and pain-free), spinal or epidural anesthesia (awake but pain-free), or local anesthesia and sedation. Choices are:

• Laser prostatectomy (laser TURP): This procedure takes about 1 to 2 hours. The laser destroys prostate tissue that blocks the opening of the urethra. You will probably go home the same day. You may need a Foley catheter placed in your bladder to help drain urine for a few days after surgery.
• Transurethral incision (TUIP): Your surgeon makes small surgical cuts where the prostate meets your bladder. This makes the urethra wider. This procedure takes 20 to 30 minutes. Many men can go home the same day. Full recovery can take 2 to 3 weeks. You may go home with a catheter in your bladder.
• Transurethral electrovaporization (TUVP): A tool or instrument delivers a strong electric current to destroy prostate tissue. You will have a catheter placed in your bladder. It may be removed within hours after the procedure or you may go home with it.
• Photoselective vaporization (PVP): A high-powered green-light laser is used to vaporize and remove excess prostate tissue with very little loss of blood.
• Prostatic urethral lift (PUL): Small implants are placed in the prostate lobes to compress the prostate tissue.
• Transurethral microwave thermotherapy (TUMT): TUMT delivers heat using microwave pulses to destroy prostate tissue. Your doctor will insert the microwave antenna through your urethra. You may need a Foley catheter placed in your bladder to help drain urine after surgery for 3 to 5 days.
• Water vapor thermal therapy (WVTT): This procedure releases sterile water vapor (steam) into the prostate to remove extra tissue. It can be done in the surgeon's office or an outpatient surgery center.
• Transurethral needle ablation (TUNA): The surgeon passes needles into the prostate. High-frequency sound waves (ultrasound) heat the needles and prostate tissue. You may need a Foley catheter placed in your bladder to help drain urine after surgery for 3 to 5 days.

Why the Procedure Is Performed

An enlarged prostate can make it hard for you to urinate. You may also get urinary tract infections. Removing all, or part, of the prostate gland can make these symptoms better. Before you have surgery, your health care provider may tell you changes you can make in how you eat or drink. You may also try some medicines.

Your provider may recommend prostate removal if you:

• Cannot completely empty your bladder (urinary retention)
• Have repeat urinary tract infections
• Have bleeding from your prostate
• Have bladder stones with your enlarged prostate
• Urinate very slowly
• Took medicines and they did not help your symptoms

Risks

Risks for any surgery are:

• Blood clots in the legs that may travel to the lungs
• Blood loss
• Breathing problems
• Heart attack or stroke during surgery
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Reactions to medications

Other risks for this surgery are:

• Erection problems (impotence)
• No symptom improvement
• Passing semen back into your bladder instead of out through the urethra (retrograde ejaculation)
• Problems with urine control (incontinence)
• Urethral stricture (tightening of the urinary outlet from scar tissue)

Before the Procedure

You will have many visits with your providers and tests before surgery:

• Complete physical exam
• Visits with your provider to make sure medical problems such as diabetes, high blood pressure, and heart or lung problems are being treated well

If you are a smoker, you should stop several weeks before the surgery. Your provider or nurse can help.

Always tell your doctor or nurse what drugs, vitamins, and other supplements you are taking, even ones you bought without a prescription.

During the weeks before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), vitamin E, clopidogrel (Plavix), warfarin (Coumadin), and other drugs like these.
• Ask your surgeon which drugs you should still take on the day of your surgery.

On the day of your surgery:

• Do not eat or drink anything after midnight the night before your surgery.
• Take the drugs your surgeon told you to take with a small sip of water.
• Your surgeon or nurse will tell you when to arrive at the hospital or clinic.

After the Procedure

Most people are able to go home the day of surgery or the day after. You may still have a catheter in your bladder when you leave the hospital or clinic.

Outlook (Prognosis)

Most of the time, these procedures can relieve your symptoms. But you have a higher chance of needing a second surgery in 5 to 10 years than if you have transurethral resection of the prostate (TURP).

Some of these less invasive surgeries may cause fewer problems with controlling your urine or ability to have sex than the standard TURP. Talk to your surgeon.

You may have the following problems for a while after surgery:

• Blood in your urine
• Burning with urination
• Need to urinate more often
• Sudden urge to urinate

References

Djavan B, Teimoori M. Surgical management of LUTS/BPH: TURP vs. open prostatectomy. In: Morgia G, ed. Lower Urinary Tract Symptoms and Benign Prostatic Hyperplasia. Cambridge, MA: Elsevier Academic Press; 2018:chap 12.

Han M, Partin AW. Simple prostatectomy: open and robotic-assisted laparoscopic approaches. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 147.

Helo S, Welliver C, McVary KT. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Partin AW, Domochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 146.

Lerner LB, McVary KT, Barry MJ, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline part II - surgical evaluation and treatment. J Urol. 2021;206(4):818-826. PMID: 34384236. pubmed.ncbi.nlm.nih.gov/34384236/.

Parsons JK, Dahm P, Köhler TS, Lerner LB, Wilt TJ. Surgical management of lower urinary tract symptoms attributed to benign prostatic hyperplasia: AUA guideline amendment 2020. J Urol. 2020;204(4):799-804. PMID: 32698710 pubmed.ncbi.nlm.nih.gov/32698710/.