Minimally Invasive Surgeries
Minimally invasive surgery is done with minimal anesthesia, as on outpatient and involves a quicker recovery. The procedure may be done in your doctor's office or at an outpatient center.
Choosing the right type of minimally invasive surgery for you may depend on:
- The size of your prostate
- How healthy you are
- Your personal choice
There are several types of minimally invasive procedures to choose from, including:
- Prostatic Urethral Lift (PUL)
- Convective Water Vapor (steam) Ablation (Rezum)
- Transurethral Microwave Thermotherapy (TUMT)
- Transurethral Water Vapor Thermal Therapy
What Are the Benefits, Risks, and Side Effects of Minimally Invasive Surgeries?
Symptom relief is the biggest benefit of minimally invasive surgery. Some men have fewer problems controlling their urine after they have one of these procedures. However, having minimally invasive surgery may increase the risk that you will need to have another surgery in the future.
Side effects from minimally invasive surgery may include:
- Urinary tract infection
- Blood in the urine
- Burning with urination
- Needing to urinate more often
- Sudden urges to urinate
- Less often:
- Erectile dysfunction
- Semen flowing backward into the bladder instead of out of the penis (retrograde ejaculation)
Minimally Invasive Surgeries and Interventions that ARE NOT recommended
- Prostate Artery Embolization (PAE)
- Transurethral Needle Ablation (TUNA)
Who Are Good Candidates for Minimally Invasive Surgery?
Men who are having trouble urinating are good candidates for minimally invasive surgery. In addition, you may be a good candidate if you:
- Have moderate to severe BPH symptoms
- Have urinary tract obstruction, bladder stones, or blood in your urine
- Can't empty your bladder completely
- Have bleeding from your prostate
- Urinate very slowly
- Have taken medications for BPH but they did not work
Prostatic Urethral Lift (PUL)
PUL (also known as UroLift®) uses a needle to place tiny implants in the prostate. These implants lift and hold the enlarged prostate so that it no longer blocks the urethra. PUL may be done with either local or general anesthesia.
What Are The Benefits, Risks and Side Effects of PUL?
PUL uses no cutting or heat to destroy or remove prostate tissue. It takes less than an hour and you can usually go home the same day. Most men see symptom improvement within about 2 weeks. However, reduction of symptoms and improvement in urinary flow may be less than with transurethral resection of the prostate (TURP).
Some men may have pain or burning when passing urine, blood in the urine, or a strong urge to urinate. These side effects usually go away within two to four weeks. Men may have fewer sexual side effects after PUL than after other types of minimally invasive surgery.
Who Are Good Candidates For Prostatic Stents?
Men with many medical problems may be good candidates. Men for whom surgery is high-risk may also be good candidates.
Many men with enlarged prostates and urinary symptoms may be good candidates for PUL. However, it is not clear if this therapy works for those prostates with a middle lobe. Men who have PUL can still have other treatment if they need it. If you are allergic to nickel, titanium, or stainless steel, talk to your doctor before getting PUL. This is a newer treatment, so it’s not clear if future treatment would be needed. There are concerns that this may not be a durable treatment as 33% of men need additional surgeries or go back on medications.
Convective Water Vapor (Steam) Ablation (CWVA, Rezum)
This treatment is also known as Rezum. This treatment uses the stored thermal energy in water vapor (steam) to kill excess prostate tissue. Inside a handheld device, sterile water is heated to just above the boiling point, when it turns into steam. A precise dose of thermal energy from the steam is then injected into the prostate with a small needle. The release of this thermal energy causes rapid cell death. The body’s natural healing response then breaks down and removes the dead tissue, causing the prostate to shrink.
What are the Benefits, Risks, and Side Effects of CWVA?
The treatment is done in the doctor’s office with local anesthesia or after you have taken a pill for pain. You may have blood in your urine and need to use a catheter for a few days. Painful or frequent urination should go away within about 3 weeks. Sexual side effects, such as erectile dysfunction, are unlikely.
Studies currently suggest that symptom improvement may last for up to 4 years. It is not currently known whether the treatment continues to work long-term or whether patients eventually need to have additional treatment.
Who are Good Candidates for CWVA?
Men may be good candidates if they don’t want to take medication for BPH, or if they have tried medication and found it didn’t work. Unlike other minimally invasive therapies, this therapy can treat men who have a middle lobe of the prostate. Men who prefer not to have surgery or want to avoid sexual side effects may also be good candidates.
Transurethral Microwave Thermotherapy (TUMT)
TUMT uses microwaves to destroy prostate tissue. The urologist threads a catheter through the urethra to the prostate. A device called an antenna sends microwaves through the catheter to heat selected portions of the prostate. The heat destroys excess prostate tissue. A cooling system protects the urinary tract from heat damage during the procedure.
What are the Benefits, Risks, and Side Effects of TUMT?
TUMT does not require anesthesia. The surgeon numbs the skin and gives you a pain pill. TUMT only takes an hour. It may relieve bladder obstruction. There is little blood loss or fluid absorption. You can usually go home the same day. TUMT poses a low risk of side effect,s such as urinary tract infections, urinary incontinence, and scarring in the urethra. About 25% of men have symptoms that may include frequent or intense urges to urinate and a burning sensation when urinating. Despite the fact that the therapy has been available for more than 20 years, the long-term effectiveness is still unclear. Very few of these are done each year and even that number is dropping rapidly as the newer therapies with more clear outcomes are replacing it.
Who are Good Candidates for TUMT?
Men with too many medical problems for invasive surgery may be good candidates for TUMT. Men with weak hearts may be good candidates because there is no blood loss. So are men who want to avoid anesthesia.
This is not therapy or a treatment but rather a temporary measure for men who cannot empty their bladders completely. A catheter is a thin, hollow plastic tube that is inserted into the bladder to drain urine. The catheter may be "clean," which means it is placed and removed every 6 to 8 hours. Or it may be "indwelling," which means it is left in the bladder for a short or long time.
A catheter can be placed in the bladder through the urethra. Or, the doctor may insert the catheter through a small puncture in the bladder, just below the navel and above the pubic bone. This is called a suprapubic catheter. A “clean” catheter is one that you, or a caregiver, can place and remove so that you do not have to wear it all the time.
What are the Benefits, Risks, and Side Effects of Catheterization?
Catheters can provide temporary relief of BPH symptoms. Infection is the biggest risk of having a catheter in place for a long time. Bacteria can stick to the catheter surface. This makes it hard for the immune system or antibiotics to work. Using a catheter for a few years increases risk for bladder cancer and can destroy the tissue of the penis. This is probably due to the long-term irritation caused by the catheter sitting in the bladder or at the meatus (urine opening at the tip of the penis). The risk of infection and cancer is lower with “clean intermittent catheterization” than with an “indwelling” catheter.
Who are Good Candidates for Catheterization?
Good candidates for catheterization include men who are waiting for medication to work or waiting for surgery. Catheters are also used during treatment for an infection. They may be a good choice for men who have multiple medical problems and a short life expectancy. The risks and discomfort of surgery may outweigh the risk of infection or cancer.