Prostate resection - minimally invasive

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 several different ways. There is no incision (cut) in your skin.

See also:

• Benign prostatic hypertrophy
• Simple prostatectomy
• Transurethral resection of the prostate

Description

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

The surgery can be done in many different ways, depending on the size of your prostate and what caused it to grow. Your doctor 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. 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 prostatectomy takes about 1 hour. 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 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.
• Transurethral microwave thermotherapy (TUMT): TUMT delivers heat using microwave pulses to destroy prostate tissue. Your doctor will insert the microwave antenna through your urethra.
• Transurethral electrovaporization (TUVP): A tool or instrument delivers high-voltage electrical current to destroy prostate tissue. You will have a catheter place in your bladder. It may be removed within hours after the procedure.
• Transurethral incision (TUIP): Your surgeon makes small incisions (cuts) where the prostate meets your bladder. As a result, the urethra becomes wider or more open. This procedure takes 20 to 30 minutes. Many men can go home the same day. Full recovery can take 2 to 3 weeks.

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 can gland can make these symptoms better. Before you have surgery, your doctor will suggest you change how you eat or drink. You may also try some medicines.

Your doctor 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
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medications

Additional risks for this surgery are:

• Problems with urine control (incontinence)
• Passing semen back into your bladder instead of out through the urethra (retrograde ejaculation)
• Erection problems (impotence)
• Urethral stricture (tightening of the urinary outlet from scar tissue)

Before the Procedure

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

• Complete physical exam
• Visits with your doctor 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 doctor 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 doctor 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 doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital.

After the Procedure

You will probably go home the day you have surgery, or the day after. You may still have a catheter in your bladder when you leave the hospital.

Outlook (Prognosis)

These procedures can usually 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 sexual performance than with the standard TURP. Talk to your doctor.

You may have burning with urination, blood in your urine, need to urinate more often, and need to urinate suddenly.

References

Fitzpatrick JM. Minimally invasive and endoscopic management of benign prostatic hyperplasia. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 88.