Less Invasive Surgery

Less Invasive Surgery

Less invasive surgery or minimally invasive surgical treatments (MIST) can often be done as an outpatient, without a stay in the hospital. Recovery time is usually quicker. It can offer relief from symptoms, including urine control problems. Some MISTS do not reduce your risk for another surgery or needing to take medications again. Be sure to ask your urologist about re-treatment rates whenever considering a MIST or even more invasive surgery.

Good candidates include men who have taken BPH medication that did not work or men with the following symptoms:

• Weak stream of urine
• Straining to start to pass urine
• Urinary tract obstruction, bladder stones and/or blood in your urine
• Incomplete emptying
• Bleeding from the prostate

There are several types of less invasive surgeries from which to choose. The option will depend on the size of your prostate, your overall health and your personal choice.

Prostatic urethral lift (PUL) uses a needle to place tiny implants in the prostate. These implants lift and compress the enlarged prostate so that it no longer blocks the urethra. These implants stay in the body forever and are not easily removed. PUL may be done with either local or general anesthesia.

With this treatment there are no cuts in the body and tissue is not destroyed or removed. Many men with enlarged prostates and urinary symptoms are good candidates. There are fewer sexual side effects with this, compared to other types of prostate surgery. MRI can still be done if you had a PUL. Talk to your doctor about how PUL may impact the image quality of future MRI used for prostate cancer detection and if you are allergic to nickel, titanium or stainless steel. Current studies have evaluated five years of treatment with PUL and future studies may help to determine long term durability.

Water vapor thermal therapy (WVTT) uses water vapor (steam) to destroy prostate cells squeezing the urethra. This treatment can be done in a doctor’s office with local anesthesia or after you have taken a pill for pain. It uses a special handheld device with a needle at the end. It combines radiofrequency energy and water to create steam. The needle and steam cause rapid cell death. The body’s natural healing response then breaks down and removes the dead tissue, causing the prostate to shrink.

Men may be good candidates if they do not want to take medication for BPH or if they have tried prescription drugs and found they do not work. Men who prefer not to have surgery or want to avoid sexual side effects may also be good candidates.

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 two to three weeks. Sexual side effects, such as erectile dysfunction, are unlikely.

Studies currently suggest that symptom improvement lasts for at least five years.

Temporary Implanted Prostatic Devices (TIPD) are placed in the prostatic urethra through a cystoscope and remain there for a period of about a week after which it is removed by the urologist. While in position, it functions to re-shape the urine channel. In re-shaping the urethra, there is a modest lessening of the prostatic obstruction and thus a modest improvement in the symptoms of BPH and improved urine flow. It is a low-risk procedure that can be inserted in the OR or in the office. It may relieve bladder obstruction. TIPD poses a low risk of side effects, such as urinary tract infections, urinary incontinence and scarring in the urethra. Some men have symptoms that include frequent or intense urges to pass urine and a burning feeling when passing urine.

Prostate Artery Embolization (PAE) is a radiologic procedure done by radiologists to block blood flow to the prostate to try to shrink the entire gland to improve symptoms. This newer procedure does not have long term data to understand its durability. PAE probably improves urinary symptoms, at least for short periods measured for less than a year. There is a shortage of substantial evidence to recommend PAE over more widely available minimally invasive therapies for the routine treatment of LUTS, but there is evidence showing a short-term benefit of PAE compared to observation in a very select patient population.

Catheterization uses a tube called a catheter in the bladder to drain urine. Catheters can be placed through the urethra or via a small puncture in the bladder above the pubic bone. This option is helpful for men with bladder control problems and a blocked prostate. Still, catheters' benefits are temporary. Infection is a risk. This treatment is best for men who are waiting for medication to work, or waiting for surgery. They also help when there is an infection, or for men toward the end of their lives, when surgery is not advised. There are two types:

• Clean, where the catheter is placed and removed every six to eight hours. This can be done by yourself or by a caregiver. For this, the catheter is removed when the urine flow stops.
• Indwelling, where the catheter stays in the bladder for longer periods of time.