Other Types of Surgery for Benign Prostatic Hyperplasia
Transurethral electrovaporization (TUEVP)
This procedure is a modification of TURP. As in TURP, the procedure involves inserting a resectoscope through the urethra. But instead of a wire loop to cut away the tissue, the resectoscope has a grooved roller at the end, which delivers a powerful electric current to vaporize prostate tissue with minimal bleeding. A catheter is placed in the bladder after the procedure.
In a meta-analysis of 20 randomized, controlled trials, investigators compared TURP with TUEVP. They found no differences in urinary symptom scores or peak urinary flow rates after one year. However, TUEVP was associated with less need for transfusion, a shorter catheterization time, and a shorter hospital stay when compared with TURP. On the other hand, TURP was associated with a lower risk of urinary retention after surgery and a lower risk of needing a re-operation when compared with TUEVP.
Transurethral incision of the prostate (TUIP)
Like TURP, transurethral incision of the prostate (TUIP) is performed with a resectoscope inserted through the urethra. However, instead of cutting away prostate tissue, the surgeon makes one or two small incisions in the prostate with an electrical knife or laser. These incisions alleviate the symptoms of BPH by decreasing the pressure that excess prostate tissue exerts on the urethra. A tissue sample is often obtained to check for prostate cancer.
TUIP takes less time to perform than TURP and, in most cases, can be done on an outpatient basis under general or spinal anesthesia. TUIP is effective only in men with prostates smaller than 30 g (about 1 oz). The degree of symptom improvement in these men is similar to that achieved with TURP, but patients may be more likely to require a second procedure. Because the incidence of retrograde ejaculation is lower than with TURP, TUIP is an option for men concerned about their fertility.
Holmium laser prostatectomy
The holmium laser has been used to remove prostate tissue. Results appear similar to those with TURP and open prostatectomy. The main advantages of the Holmium laser prostatectomy appear to be reduced blood loss and shorter catheterization times and hospital stays. Like TURP, holmium laser prostatectomy has the potential to cause ED and retrograde ejaculation.
Photoselective vaporization of the prostate (PVP)
Also called Green Light laser vaporization, photoselective vaporization of the prostate (PVP) uses a wavelength that is highly absorbed by hemoglobin. This results in minimal blood loss during the procedure. PVP allows tissue removal similar to the traditional TURP procedure while maintaining the safety characteristics of lasers.