Endoscopic Surgery for BPH
What does Endoscopic Surgery Involve?
Whenever possible, endoscopic surgery is preferable to the traditional classical open-surgery approach for treating patients with BPH.
Besides being less invasive, it has fewer risks of complications with the same effectiveness.
The aim of this procedure is to remove the enlarged part of the prostate endoscopically by removing small fragments of the prostate tissue.
There are several variants of endoscopic surgery.
The choice between the different techniques depends on the volume of the patient’s prostate and their clinical state and usual medication.
What is the Procedure for Endoscopic Surgery for BPH?
Transurethral resection of the prostate or classical endoscopic surgery.
This surgery, commonly known as TURP, continues to be the “gold standard”, i.e., the
standard technique for BPH surgery.
The procedure lasts from 45 minutes to 1 hour. During the procedure, the patient is under anaesthetic, so no pain or discomfort is felt.
The TURP technique uses a device called a resectoscope that is inserted through the urethra.
Via video visualisation and a small electrical loop (a metal filament through which a special current is run), small fragments of prostate are sectioned and removed.
At the same time, the blood vessels in the prostate are coagulated to control the haemorrhage.
The small fragments are then sent for histological analysis to check for the presence of abnormal cells that might suggest cancer.
Bipolar Transurethral Resection
This is a very similar variant of classical TURP that uses a type of loop and a special (bipolar) electrical current.
This allows surgery with a lower risk of complications of haemorrhaging and less interference, for example, in the heart rate or devices like pacemakers.
The electrical current only passes between two filaments in the resectioning device (electrodes) located a small distance from each other.
Transurethral Vaporisation of the Prostate (TVAP)
This is another variant of transurethral resection whereby a special loop is used to destroy the prostate tissue by vaporisation and dissection.
It can be used on patients with coagulation problems or who are undergoing anticoagulant therapy.
The difference with regard to classical TURP lies in the type of current used. Although effective, it generally causes greater and longer-lasting post-operative discomfort, particularly more “irritable” bladder symptoms.
Transurethral Incision of the Prostate (TUIP)
This procedure is reserved for smaller prostates. It involves making a deep cut in the prostate up to the capsule without removing any tissue.
It is faster, has less risk of complications, such as haemorrhaging, and fewer cases of retrograde ejaculation, one of the inevitable consequences of most prostate surgeries, be they endoscopic or open.
Though some patients continue to have normal ejaculation, this side effect is a consequence of the (indispensable) destruction and elimination of enlarged prostate tissue during surgery, so it is more a consequence of the surgery rather than a complication per se.
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What is the Post-Treatment for Endoscopic Surgery?
When a patient with BPH is operated on, the whole of the organ is not removed.
This is an important point to remember, because it means that normal healthy prostate tissue exists that is not removed. In other words, the part of the prostate that is “compressed” by the benign enlargement is not removed.
Therefore, patients operated on need to keep the organ under regular surveillance, both with DREs and PSA tests, as opposed to what is usually thought. (“As I’ve already been operated on, I don’t need to worry about my prostate anymore or with taking PSA tests.”)
Patients must be assessed immediately after surgery, in the following days and every day until discharged from hospital.
A consultation is required 15–30 days after surgery.
After this period, patients must have at least one annual consultation with a DRE and PSA tests for early diagnosis of prostate cancer
Dr. José Santos Dias
Clinical Director of the Instituto da Próstata
- Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
- Specialist in Urology
- Fellow of the European Board of Urology
- Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"
FAQs about Endoscopic Surgery for BPH
What is classical endoscopic surgery?
What are the different variants of the surgery?
How is classical endoscopic surgery performed?
How long does classical endoscopic surgery take?
- DIAS, José Santos. Urologia Fundamental: na prática clínica. Lisboa: Lidel - Edições Técnicas, Lda, 2010.
- DIAS, José Santos. Tudo o que sempre quis saber sobre a Próstata. Lisboa: Lidel - Edições Técnicas, Lda, 2014.
- Transurethral resection of the prostate (TURP) - https://prostatecanceruk.org/media/2491078/1609_turp_fact_sheet_ifm.pdf
- How is an enlarged prostate treated? - https://prostatecanceruk.org/prostate-information/further-help/enlarged-prostate/enlarged-prostate-treatment?scrollTo=tuvp
- Prostatectomy - https://www.mayoclinic.org/tests-procedures/prostatectomy/about/pac-20385198
- Benign Prostatic Hyperplasia (BPH) - https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-prostatic-hyperplasia-bph
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