Transurethral incision of the prostate (TUIP) for benign prostatic hyperplasia

Surgery Overview

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Transurethral incision of the prostate (TUIP) may be done to treat benign prostatic hyperplasia (BPH). The surgeon uses an instrument inserted into the urethra that generates an electric current or laser beam to make incisions in the prostate where the prostate meets the bladder. Cutting muscle in this area relaxes the opening to the bladder, decreasing resistance to the flow of urine out of the bladder. No tissue is removed. It is done under either general or spinal anesthetic.

The procedure usually requires an overnight stay in the hospital.

What To Expect After Surgery

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TUIP is a much less invasive procedure than transurethral resection of the prostate (TURP). TUIP usually requires an overnight stay in the hospital. A catheter is left in the bladder for 1 to 3 days after surgery.

Why It Is Done

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TUIP may be a good option for men with only slightly enlarged prostates.

TUIP may be chosen instead of TURP in men who:

• Are at higher risk for complications from surgery and anesthetic, including men with serious health problems. TUIP involves less blood loss and can be done more quickly than TURP.
• Want to avoid the risk of developing retrograde ejaculation, a condition in which semen flows backward into the bladder. This side effect is more common with TURP than with TUIP.

How Well It Works

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Symptoms improve after TUIP in about 80% of cases.¹ Generally, men notice about a 73% improvement in their American Urological Association (AUA) symptom index scores.² For example, if you have a score of 25 (indicating severe symptoms), it could be reduced to about 6 (indicating mild symptoms).

Short-term improvement in BPH symptoms is about the same for TUIP as for TURP. Studies comparing the two types of surgery suggest that the outcomes are similar. However, men who have had TUIP generally are less likely to develop retrograde ejaculation than men who have TURP.

Risks

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The possible risks of transurethral incision of the prostate (TUIP) include the following:

• Retrograde ejaculation, in which semen flows backward into the bladder, occurs in about 6 to 55 men out of 100.² Retrograde ejaculation is not harmful.
• Erection problems in men who did not have one of these problems before the surgery are reported in about 4 to 25 men out of 100.²
• Incontinence occurs in about 1 man out of 100.²
• The need for a blood transfusion during surgery is rare.
• A second operation because of a complication of the surgery is needed in about 1 to 3 men out of 100.²

What To Think About

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Surgery usually is not required to treat BPH, but it may be a reasonable choice for some men. Choosing surgery depends largely on your preferences and comfort with the idea of having surgery. Things to consider include your expectations, the severity of your symptoms, and the possibility of developing complications.

Usually, no tissue is removed in TUIP; therefore, no tissue is available for prostate cancer testing.

Men who have severe symptoms often have great improvement in quality of life following surgery. Men whose symptoms are mild may find that surgery does not greatly improve quality of life. Men with only mild symptoms may want to think carefully before having surgery to treat BPH.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

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Citations

1. Agency for Healthcare Research and Quality (1994). Benign Prostatic Hyperplasia: Diagnosis and Treatment. Clinical Practice Guidelines No. 8 (AHCPR Publication No. 94-0582). Rockville, MD: Agency for Healthcare Policy Research.

2. Fitzpatrick JM, Mebust WK (2002). Minimally invasive and endoscopic management of benign prostatic hyperplasia. In PC Walsh et al., eds., Campbell's Urology, 8th ed., vol. 2, pp. 1379–1422. Philadelphia: W.B. Saunders.

Credits

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Author	Ralph Poore
Editor	Susan Van Houten, RN, BSN, MBA
Associate Editor	Michele Cronen
Associate Editor	Terrina Vail
Primary Medical Reviewer	Martin Gabica, MD - Family Medicine
Specialist Medical Reviewer	Christopher G. Wood, MD, FACS - Urology/Oncology
Last Updated	March 31, 2006