If you have an enlarged prostate, but you are not finding your symptoms particularly troublesome, you may decide on a policy of watchful waiting. This means that you will not receive any immediate treatment, but you will have the option of having a transurethral resection of the prostate (TRUP) in the future if your symptoms get worse.
If you do not have a TURP, lifestyle changes, such as limiting your consumption of alcohol and taking regular exercise, may be recommended in order to improve your symptoms. See the prostate enlargement article for more information and recommendations.
Transurethral incision of the prostate (TUIP)
Transurethral incision of the prostate (TUIP) is an alternative to TURP for men who:
- only have a moderately enlarged prostate, and/or
- are in very poor health and are not suitable for TURP (TUIP generally involves less blood loss than TURP so it is a safer treatment option).
After having a TUIP, there is also a lower risk of experiencing retrograde ejaculation than there is with a TURP, which may be an important consideration for you, particularly if you wish to have children.
In some cases of retrograde ejaculation, it is possible to take a sample of sperm from your urine for use in fertility treatments such as artificial insemination, or IVF.
TUIP is carried out in a similar way to TURP, but rather than removing tissue from the prostate, two small incisions (cuts) are made in the prostate. The cuts allow your urethra to be widened, making it easier for you to pass urine.
An open prostatectomy is a type of surgery where an incision is made in your abdomen, and the outer portion of your prostate is removed.
While an open prostatectomy may be effective in treating your symptoms, it carries a high risk of complications. Therefore, it is usually only recommended for men with severely enlarged prostates.
Complications of an open prostatectomy include:
- impotence, and
- urinary incontinence.
If these complications develop following an open prostatectomy, there is a greater chance that they will become permanent compared to if they occur following TURP.
However, it may be possible to treat the symptoms of impotence with medication, such as sildenafil (Viagra).
There are a number of new surgical techniques that are broadly based on the same principle as a TURP, but they use new ways of removing the prostate tissue. Most of the newer types of surgery have fewer side effects, cause less bleeding, and the recovery time is usually quicker than a TURP.
However, as these treatments are still fairly new, their long-term effectiveness is unknown. They are also usually only suitable for men who have a moderately enlarged prostate. Men with a severely enlarged prostate will usually require a TURP.
The new techniques are explained below.
KTP laser vaporisation
KTP (potassium-titanyl-phosphate) laser vaporisation involves inserting a small tube known as a cystoscope into your urethra. The cystoscope fires pulses of laser energy in order to remove the affected section of your prostate.
Complications of KTP laser vaporisation include:
- pain while passing urine,
- urge incontinence, and
- blood in your urine - this complication usually passes within a few weeks.
Transurethral radiofrequency needle ablation of the prostate
Transurethral radiofrequency needle ablation of the prostate (TUNA) involves inserting two electrodes into your urethra and attaching them to your prostate.
Radiofrequency energy is sent to heat the electrodes in order to burn away the excess prostate tissue. Complications of TUNA include:
- retrograde ejaculation.
- bleeding, and
- urethra strictures.
Transurethral electrovaporisation of the prostate
Transurethral electrovaporisation of the prostate is a similar to a TURP, but the resectoscope is attached to a roller ball (like a mouse ball) rather than a coil of wire. High voltage electricity is passed into the ball which vaporises the excess tissue of the prostate before sealing any bleeding.
Transurethral electrovaporisation of the prostate has a similar complication rate to TURP but it is associated with less post-operative bleeding.