The specific surgical treatment of BPH commonly used are transurethral resection of the prostate, transurethral resection of the prostate, and open prostatectomy. The standard and most common surgical methods are transurethral resections of the prostate.
What are the Indications of BPH surgical treatment?
• Moderate to severe symptoms resistant to medical treatment.• Acute urinary retention.
• Recurrent urinary tract infection.
• Frequent blood in the urine.
• Renal failure due to prostate iron tumor.
What is the surgical treatment of BPH?
Surgical treatment can be divided into Transurethral resection of the prostate, Transurethral incision of the prostate, Open prostatectomy, and minimally invasive treatment.1- Transurethral resection of the prostate
TURP remains the treatment of choice for prostate surgery and the most successful of drugs. It relieves urinary obstruction in at least 85% to 90% of cases, and improvement usually lasts for long periods.TURP is a minimally invasive procedure performed by a urologist to remove part of the prostate gland that is blocking the flow of urine. Transurethral resection of the prostate does not require skin incisions or stitches. Transurethral resection of the prostate requires hospital admission.
Before Transurethral resection of the prostate
•Before performing the procedure, it is checked that the person is fit to perform the procedure.•The patient is asked to stop smoking as smoking increases the risk Of chest infection and wound infection which can delay healing.
•The patient is asked to stop taking the anticoagulant drugs (warfarin, aspirin, and clopidol).
During the Transurethral resection of the prostate
- TURP generally takes about 60 to 90 minutes.- The most effective and popular surgical treatment for BPH is transurethral resection of the prostate.
-Transurethral resection of the prostate is usually performed using spinal anesthesia. Antibiotics are given to prevent infection.
-During TURP, an instrument (resection endoscope) is inserted into the urethra through the tip of the rectum to remove the prostate.
-The resectoscope has a light, a camera for vision, an electrode to cut the tissue, the blood vessels that are causing the blockage, and the channel that carries fluid to the bladder.
-Prostate tissue removed during the procedure is sent to a lab for histopathological examination to rule out prostate cancer.
After Transurethral resection of the prostate
•The hospital stay is usually 2 to 3 days after TURP.•After surgery, a large triple-lumen catheter is inserted through the tip of the rectum (transurethral) into the bladder.
•The bladder perfusion solution is attached to the catheter and the bladder is continuously perfused and drained for 12-14 days.
•Bladder perfusion removes blood and blood clots that may result from this procedure.
•When the urine is free of significant bleeding or blood clots, the catheter is removed.
Post Transurethral resection of the prostate
The following measures after TURP can aid early recovery:•Drink plenty of fluids to clean your bladder.
•Avoid constipation and straining to defecate. Stress may increase bleeding. If bleeding occurs, take a laxative for a few days.
•Do not start taking blood-thinning medications without consulting your doctor.
•Avoid heavy lifting or strenuous activities for 4-6 weeks.
•Avoid sexual activities for 4-6 weeks after surgery.
•Avoid alcohol, caffeine, and spicy foods.
Complications of TUPR
•The most common immediate complications are bleeding and urinary tract infection, while the less common complications are TURS and problems due to surgery.•Later complications of TURP are urethral strictures, retrograde ejaculation, urinary incontinence, and impotence.
•Ejaculation of semen into the bladder (retrograde ejaculation) is a common complement to TURP in about 70% of cases. This does not affect sexual function or pleasure, but it does cause sterility.
•Factors that can increase the risk of complications are obesity, smoking, alcohol abuse, poor diet, and diabetes.
Contact the doctor if the patient suffers from:
•Difficulty or inability to urinate.•Severe pain that persists even after taking the medicine.
•Bleeding with large clots of blood or clumps of blood blocking the catheter.
•Signs of infection including fever or shivering.
Ejaculation of semen into the bladder, one of the common complications of transurethral resection of the prostate, leads to infertility (the inability to have children).
2- Transurethral incision of the prostate
TUIP is an alternative procedure to TURP for men with a smaller prostate or very poor health who are therefore not suitable for TURP.TUIP is performed in a similar way to TURP but instead of removing tissue from the prostate, two or more long-deep incisions (cuts) are made in the prostate. The cuts widen the urethra, relieve pressure on the urethra, and improve urine flow.
The benefits of TUIP are less blood loss, fewer complications after surgery, shorter hospital stay and recovery time, and lower risks of retrograde ejaculation and urinary incontinence.
3- Open prostatectomy
Open prostatectomy is a type of surgery in which an incision is made in the abdomen and the prostate is removed. With many more effective and less invasive methods available, open prostatectomy is rarely used to treat BPH.Open prostatectomy is only performed in a very small number of men with a significantly enlarged prostate and in patients with other problems that need simultaneous correction during surgery.
Transurethral resection of the prostate represents an alternative procedure to TURP for men with a smaller prostate or patients who are at high risk for TURP.
4- Minimally invasive treatments
Minimally invasive methods are at least those that harm patients. With modern technology and research, minimally invasive treatments aim to treat BPH in a simpler and less invasive way.Heat, laser, or electrophoresis to remove excess tissue from the prostate. All of these treatments use the transurethral approach (climbing up through the urethra from inside the rectum).
The benefits of minimally invasive treatments are less hospital stay, the need for minimal anesthesia, fewer risks and complications than standard prostate surgery, and a shorter recovery time for the patient.
The disadvantages of these methods are less efficacy than the standard TURP procedure as the patient is likely to need another prostate surgery after 5 or 10 years and the inability to examine prostate tissue histologically (to rule out hidden prostate cancer) And the lack of long-term studies of the safety and efficacy of the prostate.
An important additional disadvantage is that minimally invasive treatments are not available in most developing countries and are currently considered more expensive.
Surgical treatment of benign prostate tumor in Transurethral Microwave Thermal Therapy ( TUMT), Low-Dose Radiation Instead of Heat ( TUNA), Water Stimulated Thermal Therapy ( WIT) Prostate Stenting, and Transurethral Laser Therapy.
A. Transurethral Microwave Thermal Therapy ( TUMT): In this procedure, excess prostate tissue blocking urine flow is burned using microwave heat. Benefits of minimally invasive treatments: lower risks and shorter hospital stay Concerns: lower cost, longer hospitalization, prostate safety Prostate hyperplasia device using low doses of radiation energy instead of heat.
B- TUNA: In this procedure, excess prostate tissue that blocks urine flow is necrotized and coagulated using radiofrequency energy.
C- Water Stimulated Thermal Therapy ( WIT) In this technique, hot water causes heat-stimulated coagulation and necrosis of excess prostate tissue.
D- Prostate Stenting, In this technique, a stent is placed within the narrowed area of the prostatic urethra. The stent keeps the urethra open and allows the patient to urinate easily. The struts are flexible and are self-expanding titanium wires shaped like springs or small coiled tubes.
E- Transurethral laser therapy In this technique, laser energy destroys the parts that block the prostate by heating it.
