Minimally Invasive Treatments for BPH (Benign Prostatic Hyperplasia)

Johns Hopkins Health Alerts Prostate Disorders Treatments for BPH (Benign Prostatic Hyperplasia)

Transurethral prostatectomy (TURP) is the gold standard treatment for BPH (benign prostatic hyperplasia), but in recent years, clinicians have developed and refined a number of minimally invasive alternatives for those patients with prostate disease.
Two such treatments for BPH—transurethral needle ablation (TUNA) and transurethral microwave thermotherapy (TUMT)—have become increasingly popular among prostate patients because of their ability to relieve symptoms of BPH while producing fewer serious side effects, like bleeding and sexual dysfunction, compared with TURP.
Both of these newer BPH treatments utilize heat. In TUNA, prostate tissue is destroyed with heat delivered by low-energy radio waves through tiny needles at the tip of a catheter inserted into the prostate through the urethra. TUMT uses microwave energy—also delivered by means of a catheter inserted in the urethra—to heat and destroy prostate tissue.
Though they are less invasive than TURP, quality-of-life studies show that TURP has a greater positive impact on perceptions of urinary difficulty for those with BPH than minimally invasive alternatives. Knowing what to expect from these treatments can help you decide whether TUNA or TUMT is right for you.
Immediately After Procedure
TUNA and TUMT are outpatient procedures, and you will be able to go home soon after the sedative wears off (usually about an hour after the procedure). Because of the sedative, someone will have to drive you home, and you should avoid driving for the next 24 hours. Following the treatment, you may experience some discomfort or pain, which can be relieved by taking Tylenol. You should also drink plenty of fluids while recovering to help flush the bladder and avoid blood clots.
Because TUNA and TUMT irritate tissue in the urethra, most men have difficulty urinating immediately after the procedure. For this reason, a catheter will be placed in your urethra to prevent urinary retention, and you will be instructed in how to use the catheter before you go home.
Days and Weeks Afterward
The amount of time you will need the catheter depends on a number of factors. TUNA generally requires a shorter catheterization period (1 to 5 days) than TUMT (2 to 14 days), and men with smaller prostates require catheterization for shorter durations than those with larger prostates. Your urologist may instruct you on how to remove the catheter on your own at home or may ask you to return to the office to have it removed.
Patients can usually return to their normal activities after the catheter is removed. While the catheter is still in place, you should avoid heavy lifting and vigorous exercise.
Possible Complications
While minimally invasive procedures for BPH are often associated with less severe complications than TURP, they still can cause side effects, including the following:

Difficult or painful urination. These problems are common in the first days after the catheter is removed, but they typically improve after a week or two. If urinating is extremely painful or does not improve, contact your urologist.

Blood in the urine. A small amount of blood that lends a pinkish hue to your urine may cause you some anxiety but is common for up to three days after the procedure. However, if the bleeding is heavy, lasts more than a few days, or causes blood clots that block the flow of urine, call your urologist.

Urinary tract infections. These infections usually result from catheterization; the longer you have a catheter, the higher your risk of infection. To reduce this risk, antibiotics are often prescribed either after the procedure or after catheter removal.

Urinary retention. A small number of BPH patients are unable to urinate on their own after catheter removal and may require a longer period of catheterization. If this happens, contact your doctor.

Sexual dysfunction. In general, the rates of sexual dysfunction are thought to be lower with TUNA and TUMT than with TURP. Nonetheless, men can experience retrograde ejaculation (ejaculation into the bladder instead of through the penis) after TUNA and TUMT. In one study, one in five men reported retrograde ejaculation after TUMT. However, most studies show that TUNA and TUMT have no major adverse effects on sexual function.

Severe abdominal pain or a high fever. Contact your doctor if you experience either of these symptoms.

When Will BPH Urinary Symptoms Improve?
Symptoms of BPH usually do not improve immediately after TUNA or TUMT; instead, they worsen for a few days and then slowly improve. In fact, you may notice no improvement in BPH symptoms for about two to eight weeks. This delay in BPH symptom relief occurs because it takes time for the body to absorb and discard the excess prostate tissue destroyed by the procedure.
If TUNA or TUMT is effective, you will experience its full benefits within three to six months. However, BPH symptom relief is not always long lasting. After two years, about 20% of men need retreatment either with TUNA, TUMT, or TURP, and this rate increases to about 33% after five years.

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