Other Surgical Interventions
Procedures that look to remove tissue to create a wide cavity through the prostate remains the mainstay of true surgical treatment. This approach has stood the test of time in achieving predictable, significant and long lasting improvements in symptoms. Whilst on average all these procedures are at least twice as good as the MISTS, they carry with them the burden of impact on sexual function. Patients should expectdry ejaculation and running the risk of some negative impact on erectile function following the procedure. The most commonly performed procedure in the treatment of symptomatic benign prostatic enlargement (BPE) remains the TURP (trans urethral resection of the prostate). Global experts in this field would suggest that whilst there has been significant evolution in related technology, noticeably the introduction of the PLASMA system, TURP may remain the reference procedure for some patients, but has not been the often quoted ‘Gold Standard’ for over 20 years. Furthermore, evidence suggests and guidelines have concluded, that TURP should only be offered to men within a limited range of prostate volumes (30 to 80ml).
More than 20 years ago, we saw the introduction of laser technology, both Greenlight laser and HoLEP offering attractive alternatives to the TURP, be it related to overall safety, reduced risk of bleeding if taking blood thinners, better efficacy in larger prostates and better longevity of benefit. It is only in the last few years that a true alternative has emerged, in the form of Aquablation of the Prostate using the Aquabeam system. 2022 and 2023, have seen the publication of mature (5 year) data, confirming that Aquablation is at least as effective as that reference standard TURP, perhaps more effective in larger prostates and as a technology is applicable to almost all sizes of prostate. Its unique selling point relates to these outcomes being achieved at a much lower risk of negative impact upon sexual function , be it related to ejaculation or erection. Being a heat free procedure, whilst the need for a post operative urinary catheter (drainage tube from the bladder) and in hospital stay may not differ greatly from what is possible with plasma TURP and the lasers, the recovery of symptoms and return to normal activity maybe quicker.
Transurethral Resection of the Prostate
The original minimally invasive surgical treatment for the symptomatic BPE, the TURP grew in popularity in the 70s and 80s in the UK replacing open surgery. Involving the passing of a telescope down the water pipe, under vision, a ½ moon of wire or loop is energised with electricity to allow the gradual and sequential trimming of prostate tissue, to create a wide cavity throughout the length of the prostate. Tissue is sent for analysis and a urinary catheter is placed, usually requiring post operative bladder irrigation whilst bleeding settles itself down. The catheter is usually removed a day or 2 later, although on occasion it may be left in place for a little longer.
