Other Treatments
Several surgical approaches are now available.
Invasive Procedures. The most effective surgical procedures, transurethral resection of the prostate (TURP) and open prostatectomy, are also the most invasive. They carry the highest risks for significant complications, including impotence and incontinence. Greater experience with TURP, however, has reduced complications and hospital stays. Because it is more effective than less invasive procedures, TURP remains the procedure of choice for many doctors. When considering invasive surgery, the patient should be sure his surgeon performs at least 50 of these procedures each year. The complication rates of the surgeon should be no higher than 1% for incontinence and 4% for impotence. Transurethral incision of the prostate (TUIP) is an alternative to TURP for men with smaller prostate glands.
Less Invasive Procedures. Minimally invasive procedures use some form of heat to destroy excess prostate tissue. The heat may be delivered by:
- Radio frequency. Transurethral needle ablation (TUNA)
- Microwave. Transurethral microwave thermotherapy (TUMT)
- Electrical current. Transurethral electrovaporization (TUVP)
- Ultrasound. High-intensity focus ultrasound (HIFU)
- Hot water. Water-induced thermotherapy (WIT)
- Laser. Interstitial laser coagulation (ILC) and holmium laser enucleation of the prostate (HoLEP)
One laser procedure, photoselective vaporization (PVP), is typically done as an outpatient procedure. The patient goes home on the same day. However, there is no long-term data for this procedure.
None of the other minimally invasive procedures have proven superior to TURP to date, but they vary by complications. Some may be appropriate for certain patients, such as the following:
- Younger men. (Many of the less invasive procedures carry a lower risk for impotence and incontinence than TURP, although the risk for TURP is not high.)
- Debilitated elderly patients.
- Patients with severe medical conditions, including uncontrolled diabetes, cirrhosis, active alcoholism, psychosis, and serious lung, kidney, or heart disease.
- Men who are on blood-thinning drugs.
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