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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.
PAE has also recently been recommended by the National Institute for Health and Care Excellence in the United Kingdom as a viable option. Read the BBC news article.
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.
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.
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| Transurethral Resection of the Prostate (TURP) | ||
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| **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. | ||
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 Trial” Radiology, 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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