If you have an enlarged prostate -- known medically as benign prostatic hyperplasia -- and you don't want to take any more medication, you might be interested in minimally invasive therapy. The goal of the surgery is to improve the flow of your urine through your urethra, which carries urine out of the body when you urinate.
What Makes Them 'Minimally Invasive?'
Minimally invasive surgery is performed in a variety of ways. You will most likely have it done as an outpatient under anesthesia, and you will go home with a urinary catheter that you will need for a few days until you heal.
According to the American Urological Association, these treatments (see below) do better at symptom relief than medication, but they don't work as well as a transurethral resection of the prostate (TURP) -- the gold standard in surgery for BPH. What makes these treatments "minimally invasive" is that they are performed using the smallest cameras (or scopes) and small surgical instruments available today.
Minimally invasive treatments of the prostate generally use either heat, laser, or electrovaporization to remove excess tissue from the prostate. All of these treatments use a transurethral approach -- transurethral means the treatment involves going up through the urethra in the penis.
Usually, a surgeon will use a tiny scope to guide and target tissue that will be destroyed, and help free up pressure from your prostate on the urethra. Proponents of these techniques believe that minimally invasive surgery lets you recover faster, feel less pain, and that means that you can go under local, rather than general anesthesia.
Are Procedures for Me?
Discuss with your doctor which procedure is most appropriate for you, based on your symptoms and preferences.
- Transurethral microwave thermotherapy (TUMT). A transurethral catheter cools down mucosal tissue. Then, the microwave treatment is guided through a scope. It pinpoints the excess tissue and destroys it using microwave heat.
- Transurethral needle ablation of the prostate, also known as TUNA. This technique heats the prostate tissue using radio waves. In a similar fashion to the microwave technique, the needle is guided using a rigid scope.
- Transurethral laser therapy. The term "laser" is an abbreviation for "light amplification by stimulated emission of radiation." Laser is a source of energy. Depending on the type of laser used, laser works differently. One effect that can be achieved within months of treatment is coagulation necrosis, which refers to killing off excess cell growth. Other lasers ablate or erode tissue by vaporization.
According to a comprehensive review, minimally invasive procedures such as the ones listed above all seem to be fairly good alternatives to the more invasive (but highly effective) procedure known as TURP.
Advantages of Minimally Invasive Therapies
Many urologists and patients prefer these procedures for many reasons. First of all, they can usually be performed on an outpatient basis. Another advantage is that they can eliminate the need for prostate medications. Recovery time appears to be shorter than that for transurethral resection of the prostate, which is done as an inpatient procedure.
Disadvantages of Minimally Invasive Therapies
Minimally invasive prostate surgery has some drawbacks that you should know about. Since these techniques destroy tissue, the tissue is not available for laboratory studies, for example, studies that would detect prostate cancer. There also have been very few long-term studies to show how long these treatments last. Some of the treatments, particularly laser therapy, are costly.
Berardinelli F, Hinh P, R. Wang. Minimally invasive surgery in the management of BPH. Minerva Urol Nefrol 2009 62(3):269-289.
Hoffman RM, Monga M, Elliot SP, Macdonalald R. Wilt TJ. Microwave thermotherapy for benign prostatic hyperplasia. Cochrane Database Syst Rev 2007;4:CD004135.
Presti JC, Kane CJ, Shinohara K, Carroll. PR. Neoplasms of the prostate gland. Chapt. 22. In: Tanagho EA, McAninch, eds. Smith's General Urology. 17th ed. 2008. New York: McGraw Hill.