Transurethral Resection of the Prostate (TURP)
TURP, the gold standard of effective treatment for BPH, involves removal of the core of the prostate using an instrument passed through the urethra. High frequency current flowing through a wire loop allows removal of “chips” of prostatic tissue and coagulation of blood vessels. The prostate tissue is removed through the cystoscope used to visually guide and monitor this process. Patients require a urethral catheter for 2 days and usually stay in the hospital for 2 days. Most patients (80% to 90%) experience dramatic improvement in their symptoms and urinary flow rates after TURP. Possible side effects include bleeding requiring transfusion, salt imbalances from fluid absorption, impotence (less than 5%) and incontinence (1% to 2%).
Transurethral Incision of the Prostate (TUIP)
TUIP similar to TURP. Instead of removing prostatic tissue, an electrical knife is used to make small cuts in the prostate. This relieves pressure on the urethra and generally results in decreased symptoms and increased flow rates. TUIP is generally used in smaller prostates.
Open Prostatectomy
Open prostatectomy is performed for those patients with very large prostates (greater than 80 grams) in whom transurethral surgery would be difficult to perform safely. In this procedure, an incision is made from the navel to the pubic bone. The bladder is opened; and prostatic tissue is removed through the bladder. A urethral catheter remains for approximately 7 days and patients stay in the hospital 5-7 days. It is a more invasive procedure, and complications include bleeding and infection.
Robotic Prostatectomy
This surgery can also be performed with the da Vinci® Surgical System in a minimally invasive procedure called a robotic-assisted simple prostatectomy. Compared to the open simple prostatectomy, robotic techniques allow more precise removal of the inner part of the prostate with smaller incisions, reduced blood loss, less need for blood transfusion, less pain, shorter hospital stay (usually 1 to 2 days versus a week), and faster overall recovery before a return to normal activities.