Invasive, Non-Surgical Treatment for BPH

TUNA: Transurethral Needle Ablation

Transurethral needle ablation (TUNA) of the prostate. This procedure, which can be done in a doctor’s office, utilizes radio waves to “burn away” excessive prostate tissue. Before treatment, the clinician needs to determine the length and width of the prostate. To perform TUNA, the clinician inserts a catheter into the tip of the penis and pushes it through the urethra until it reaches the spot where the urethra is surrounded by and “squeezed on” by the prostate. Once the catheter is in place, the needles on its tip send out high-temperature (110 degrees F), low-level radio waves that destroy selected prostate tissue. This allows the “strangled” urinary passageway to enlarge. You may notice a significant improvement in symptoms, but they won’t happen overnight. Until the area heals completely, you can also expect to need to urinate frequently. Another drawback is that you may need to have TUNA repeated every several years as the prostate continues to grow. The need for retreatment every two years occurs in 14 percent of cases, according to one study. (Schulman 1995) TUNA also does not work well in men who have large prostates, and it is generally considered to be less effective than prostate surgery. Other complications may include blood in the urine, infection, and rarely, sexual dysfunction or urethral stricture.

TUMT: Transurethral Microwave Thermotherapy

TUMT stands for transurethral microwave thermotherapy, which combines heat and cold to relieve BPH symptoms with a minimum of side effects. Similar to TUNA, the clinician needs to know the length and width of the prostate prior to the procedure, which can be performed in an office setting. Once again, a catheter is threaded through the penis until it reaches the part of the urethra that is being strangled by the prostate. This catheter contains a special antenna that sends out microwaves into the prostate to destroy excess tissue. At the same time, cold water is circulated through the catheter to protect healthy prostate tissue from being damaged by the heat, to reduce any discomfort associate with the procedure, and to reduce the risk of side effects. TUMT takes about one hour and can be performed while you are fully awake or under light sedation. A catheter is needed for one to three days after the procedure. Potential side effects include needing to urinate frequently, inflammation of the urethra, and a pink discharge in the urine. This procedure works best for men who have mild BPH symptoms or who have no history of urinary retention, and it usually takes several weeks after TUMT before you will notice any improvement and 90 days before you experience the full benefits.

PVP: Photo-Selective Vaporization

The acronym PVP stands for photo-selective vaporization of the prostate, a procedure that allows clinicians to vaporize excess prostatic tissue and heat seal the site simultaneously. PVP is approved for prostates up to 60 grams and is performed via a high-energy laser (a potassium titanyl phosphate, or KTP laser) that is inserted into the penis and threaded through the urethra to the part where the urethra is surrounded by the enlarged prostate. The laser light vaporizes the excess prostate tissue so there is no “dying” prostate tissue left behind to clean up later. The heat generated by PVP seals the blood vessels so bleeding is kept to a minimum. The entire procedure takes about 30 minutes or less to perform, and it is done on an outpatient basis. The main side effect is blood in the urine.

Holmium Laser Ablation of the Prostate

Holmium laser ablation of the prostate (HoLAP) uses laser energy to relieve symptoms of an enlarged prostate and remove prostate tissue that is obstructing urinary flow. Use of holmium laser ablation of the prostate is an alternative to TURP and is associated with far few side effects and complications. The decision whether to use HoLAP or another procedure called holmium enucleation of the prostate (HoLEP) is based mainly on the size of the prostate. Ablation usually is done for men whose prostate is smaller than 60 cubic centimeters while HoLEP is used for men who have a larger prostate.

Holmium laser energy is delivered through a thin flexible fiber that is passed into the penis. The clinician can control the laser with a very high degree of precision to vaporize the obstructive prostate tissue and seal the area, resulting in little to no bleeding. The entire procedure typically takes one hour or less. Holmium laser can also be used to break up and remove bladder stones during prostate treatment.

Men who undergo HoLAP usually can go home without a catheter after a few hours or overnight. Pain medication is rarely needed, retreatment rate is less than 2 percent, sepsis is an uncommon possibility, and there is virtually no effect on erectile function. Men can typically return to normal activities soon after going home, although they can expect to experience some blood in their urine for 1 to 2 weeks. Urinary incontinence is common, but permanent incontinence at one year after the procedure occurs in only about 1 percent of men. Bladder perforation is rare.

Interstitial Laser Therapy

Interstitial laser therapy, also called interstitial laser coagulation (ILC), is an inpatient procedure that utilizes laser energy to heat and destroy overgrown prostate tissue that is causing obstruction of urine flow. The laser energy is delivered to the prostate through a cystoscope that is inserted through the penis, where it destroys the cells that are blocking the flow of urine. Interstitial laser therapy is associated with minimal blood loss, does not cause retrograde ejaculation or erectile dysfunction, and can be performed with a local anesthetic. (Brosman 2009) A catheter is usually required for three days after the procedure, and symptoms should improve over six to twelve weeks.

TUBD: Transurethral Dilation – Pushing the Prostate

If your doctor chooses the TUBD (transurethral dilation) of the prostate for BPH, he or she will literally push your enlarged prostate tissue away from the urethra. To accomplish this, it is necessary to insert a small balloon into the penis and push it through the urethra until it is in the part of the urethra that passes through the prostate. The balloon is then inflated and the big push occurs. Although the idea is intriguing—to eliminate the prostate’s stranglehold on the urethra without burning or cutting anything—the results of the TUBD are usually not all that impressive, so the procedure is not widely used.

Stent: Prop It Open

Clinicians can use a little coil called a stent to prop open the urethra so the urine can flow freely. To implant a stent, it is necessary to insert it through the tip of the penis and guide it to the appropriate spot in the urethra. No cutting, heating, or lasering is involved in this process. However, stents are not a long-term solution, as they can be either temporary or permanent, and they don’t work at all for some men. The success rate ranges from 50 to 90 percent, and there is a high rate of complications. Some of those complications include stents that shift position, break, or cause pain or infection, and there’s a good chance tissue will grow over the stent, transforming the stent into a kind of dam in the urethra. Stents are an alternative for men who cannot or will not take medications or go under the knife to treat BPH. A stent can be used in high-risk patients or in men who are experiencing urinary retention and awaiting other treatment.

Prostatic Arterial Embolization: An Emerging Therapy

A new minimally invasive BPH treatment that is still in clinical trials is prostatic arterial embolization (PAE), an outpatient procedure designed to reduce the size of the prostate so urinary flow can resume. During a PAE procedure, the clinician makes a percutaneous puncture in the upper thigh to access the prostatic arteries that supply blood to the prostate. The clinician then injects Embosphere® Microspheres (microbeads designed to block blood supply to tumors) through a catheter.

Thus far, results of a clinical involving 11 patients found that 10 have an average 30 percent reduction in prostate volume after undergoing the PAE procedure. After following all the men for a minimum of ten months, 10 of the 11 men achieved clinical success and an improvement in their quality of life. The eleventh patient did not respond to PAE and was referred for transurethral resection of the prostate (TURP).

Studies of PAE indicate it has promise as an alternate treatment option for BPH. However, more clinical trials are required before it may be ready for widespread patient use.

References

Brosman SA. Interstitial laser coagulation of the prostate. 2009 emedicine: http://emedicine.medscape.com/article/445105-overview

Schulman CC, Zlotta AR. Transurethral needle ablation of the prostate for treatment of benign prostatic hyperplasia: early clinical experience. Urology 1995; 45:28-33.