Prostate Surgery: Is There an Alternative to TURP?

Mayfair • Nov 09, 2017

As men age, their prostate grows; it’s a fact of life. It's usually not a serious problem, but over 30 percent of men aged 50 and over require treatment for an enlarged prostate and for some of them that means surgery.

The prostate gland sits underneath the bladder and surrounds part of the urethra, the tube that carries urine and semen out of your penis. Normally, it’s the size and shape of a walnut, but as men age it can sometimes get too big and start to squeeze the urethra. This is called benign prostatic hyperplasia (BPH). It can disturb sleep with frequent urination overnight, or cause a hard time urinating or a weak stream when you do start.

BPH is not prostate cancer, nor does it make you more likely to get it. It’s a common condition with a number of treatment options, ranging from lifestyle changes to medication to surgery. Your health care practitioner can help you determine the best option for you based on your age, health, and current symptoms.

In cases of surgery, the most commonly performed procedure is a transurethral resection of the prostate (TURP). Very large prostates are not effectively treated with TURP, so an open surgery is usually performed to completely or partially remove the enlarged prostate. These are not the only options however. Mayfair Diagnostics radiologists have been successfully performing prostate artery embolization (PAE) procedures as an alternative to surgery in Calgary hospitals since 2012.

WHAT IS PAE?

First performed in 2009 by Professor Pisco in Portugal, this new procedure shrinks an enlarged prostate by non-surgically blocking the arteries that feed the gland. An interventional radiologist, rather than a surgeon, performs the procedure through a pinhole in the groin.

The interventional radiologist will use X-ray guidance to move a small plastic tube into the small arteries which are feeding the prostate. A special X-ray dye is injected down the catheter to identify the prostate blood supply. Then fluid containing thousands of tiny plastic particles is injected into these small arteries to block them and starve the prostate of its blood supply.

PAE is done using a local anesthetic in the groin and intravenous painkillers and/or sedatives, if needed. A catheter is inserted into the bladder for a few hours during the procedure.

WHAT IS TURP?

During a TURP, an instrument is inserted into the tip of your penis and extended through your urethra into the prostate area. Your doctor will then use it to trim tissue from the inside of your prostate gland, one small piece at a time, to remove the section of the prostate that is blocking urine flow. As small pieces of tissue are removed, irrigating fluid carries them into your bladder.

TURP is done using a general or spinal anesthetic and a catheter will be inserted into your bladder. It usually requires a one- or two-day stay in the hospital and the catheter is generally left in place for at least 24 to 48 hours, until the bleeding subsides.

HOW DO THESE SURGICAL OPTIONS COMPARE?

Prostate Artery Embolization (PAE)

Benefits    Risks
  • It’s less invasive with no risk of bleeding and other surgical complications.
 
  • Your prostate is slowly deprived of its blood supply, so it may take up to six months for you to see the full benefit of PAE.
  • Larger prostates can be treated effectively with PAE.
 
  • Difficulty in finding small prostate arteries may lead to PAE failure in around 10 percent of cases. In these cases, you may benefit from traditional TURP surgery.
  • There is usually no hospital stay required.
 
  • As  a relatively new procedure the long term effectivess is unclear, although data up to around five years shows a good long term benefit.
  • There is no impact on erectile or sexual function.
 
  • There is a small risk of “non-target embolization” where particles go to the wrong area in the pelvis.
     

Transurethral Resection of the Prostate (TURP)

Benefits    Risks
  • It’s a well-established procedure.
 
  • Retrograde ejaculation: Ejaculation into the bladder is very common, occurring in most men who have TURP. This does not affect erectile function, but alters the experience of ejaculation and affects your ability to father a child.
  • Relief from urinary symptoms is rapid upon recovery from surgery.
 
  • There is a small risk of impotence after TURP which is hard to quantify, with variable rates in different studies.
   
  • There are small risks of significant bleeding, infection, and incontinence associated with TURP.

**SPECIAL NOTE: TURP is not effective for patients who have a very large prostate (3 times normal size), so they are usually sent for open prostatectomy – the prostate is removed through an incision above the pubic bone. This carries the usual surgical risks, especially for patients in their 70s and 80s who commonly have this problem combined with other health issues. There is also a risk of incontinence. A pinhole surgery without general anesthetic, such as PAE, would be more effective for these patients as well.

 

HOW DO I GET A PAE?

You will need to speak to your health care practitioner about your options and get a referral to a urologist.


REFERENCES

Gao, Y., et al. (2014) “Benign Prostatic Hyperplasia: Prostatic Arterial Embolization versus Transurethral Resection of the Prostate—A Prospective, Randomized, and Controlled Clinical TrialRadiology, Mar; 270 (3): 920-28. Accessed October 30, 2017.

Hacking, N. (2012) “Prostate artery embolization.” University Hospital Southamption, NHS Foundation Trust. www.uhs.nhs.uk Accessed October 30, 2017.

Kapoor, Anil (2012) “Benign prostatic hyperplasia (BPH) management in the primary care setting.” The Canadian Journal of Urology, Oct. 19(1): 10-17

Martin, L. J. (2016) “What is BPH?” WebMD Medical Reference, www.webmd.com Accessed October 30, 2017.

Mayo Clinic Staff (2017) “Transurethral resection of the prostate (TURP).” www.mayoclinic.org Accessed October 30, 2017.

Movember Foundation (2017) “Men’s Health: Prostate Cancer.” www.ca.movember.com Accessed October 30, 2017.

MyHealthAlberta (2017) “Transurethral Resection of the Prostate (TURP) for Benign Prostatic Hyperplasia.” www.myhealthalberta.ca Accessed October 30, 2017.

Nickel, J.C., et al. (2010) “2010 Update: Guidelines for the management of benign prostatic hyperplasia.” Canadian Urological Association Journal, Oct. 4(5): 310-16

Ontario Pharmacists’ Association (2012) Continuing Education: Therapeutic Options Focus on Benign Prostatic Hyperplasia. The Drug Information and Research Centre, Jan/Feb/Mar insert

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