Transurethral incision of the prostate (TUIP)

Definition

Transurethral incision of the prostate (TUIP) is a type of prostate surgery done to relieve urinary symptoms caused by prostate enlargement, also known as benign prostatic hyperplasia (BPH).

During TUIP, a combined visual and surgical instrument (resectoscope) is inserted through the tip of your penis and into the tube that carries urine from your bladder (urethra). The urethra is surrounded by prostate tissue. No prostate tissue is removed during TUIP. Instead, the doctor cuts one or two small grooves in the area where the prostate and the bladder are connected (bladder neck) in order to open up the urinary channel. This allows urine to pass through more easily.

When deciding whether TUIP or another treatment is a good option for you, your doctor will consider how severe your symptoms are, what other health problems you have, and the size and shape of your prostate.

Before doing any enlarged prostate procedure, your doctor may want to do a test that uses a visual scope to look inside your urethra and bladder (cystoscopy). This allows the doctor to check the size of your prostate and examine your urinary system. Your doctor may also want to do other tests, such as blood tests or tests to measure urine flow.

Why it's done

TUIP is used to ease urinary symptoms caused by an enlarged prostate. Symptoms can include:

• A frequent, urgent need to urinate
• Difficulty starting urination
• Slow (prolonged) urination
• Increased frequency of urination at night (nocturia)
• Stopping and starting again while urinating
• The feeling you can't completely empty your bladder
• Urinary tract infections

TUIP may also be done to treat or prevent complications due to blocked urine flow, such as:

• Recurring urinary tract infections
• Kidney malfunction or kidney damage
• Bladder damage, which can result in an inability to control urination (incontinence)
• Blood in your urine
• Bladder stones

TUIP is an option only when the prostate gland is relatively small — less than about 1 ounce (30 milliliters) in size. If you have a larger prostate or you have severe urinary symptoms, a different procedure may be a better option.

Other enlarged prostate procedures include transurethral resection of the prostate (TURP), transurethral needle ablation (TUNA), transurethral microwave therapy (TUMT), laser surgery such as holmium laser enucleation of the prostate (HoLEP) or laser photovaporization of the prostate (PVP), and open prostatectomy.

TUIP is less likely than TURP or open prostatectomy to cause serious bleeding and surgery-related complications. Other enlarged prostate treatments, including holmium laser enuclation of the prostate (HoLEP), appear to be more effective than is TUIP at easing urinary symptoms in the long run.

Risks

Risks of TUIP can include:

• Temporary difficulty urinating. You may have trouble urinating (urinary retention) for a few days after the procedure. Until you can urinate on your own, you will need to have a tube inserted through your penis to carry urine out of your bladder (urinary catheter).
• Urinary tract infection. Urinary tract infections are a possible complication after any enlarged prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place and may require antibiotics or other treatment.
• Difficulty holding urine. You may have trouble controlling urination (urinary incontinence) right after surgery. Rarely, this is a long-term consequence of TUIP.
• Dry orgasm. TUIP can cause retrograde ejaculation, which means semen released during sexual climax (ejaculation) enters your bladder rather than exiting the penis. Retrograde ejaculation isn't harmful and generally doesn't affect sexual pleasure. But it can interfere with your ability to father a child.
• Erectile dysfunction. The inability to keep or maintain an erection is a possible long-term side effect, but is less common with TUIP than with open prostatectomy or with TURP.
• Need for retreatment. Some men who have TUIP later require follow-up treatment with TURP or another prostate procedure. Treatment is needed either because symptoms return over time or because they never adequately improve.

How you prepare

Follow your doctor's instructions on what to do before your treatment. Here are some things that you may need to do:

• Ask about blood-thinning medications. Your surgeon may ask you to stop taking medications that increase your risk of bleeding several days prior to surgery. These include warfarin (Coumadin), clopidogrel (Plavix), and nonprescription pain relievers such as aspirin, ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Talk to the doctor who prescribed your medication before you make any changes.
• Don't eat before your procedure. Your doctor will likely ask you to not eat or drink anything after midnight. On the morning of your procedure, take only the medications your doctor tells you to with a small sip of water.
• Arrange a ride home. You won't be able to drive yourself home after the procedure. You may be able to go home the day of surgery, or you may need to stay in the hospital overnight. Ask your doctor ahead of time when you can expect to go home.
• Plan for time off work. You may not be able to work or do strenuous activity for several weeks after surgery. Ask your doctor how much recovery time you may need.

Your doctor may also give you other steps to follow.

What you can expect

TUIP typically takes 20 to 30 minutes. You'll receive either a general anesthetic, which will put you to sleep, or an anesthetic that blocks feeling from the waist down (spinal block).

During the procedure
Your doctor may put numbing gel inside your urethra and may numb the prostate area with an injection given through your rectum.

Once the anesthetic is working, your doctor will insert a combined visual and surgical instrument (resectoscope) into the tip of your penis and extend it to the prostate area. The resectoscope is equipped with a lens or camera, a cutting device, and valves to release fluid to wash (irrigate) the surgery area. The resectoscope is about 12 inches (30.5 centimeters) long and 1/2 inch (1 centimeter) in diameter. It has a light, valves for controlling irrigating fluid, and an electrical loop to cut tissue and seal blood vessels. Irrigating fluid is used to lubricate the urethra and rinse away blood.

Using the resectoscope, the doctor makes one or two incisions on the inner surface of the prostate where the bladder joins the prostate (bladder neck).

After the procedure
You may be able to leave the hospital the day of the procedure, or you may need to stay overnight. Talk to your doctor about what you can expect, and any precautions you need to take after you go home.

• You'll have a catheter in place that enters through the tip of your penis and goes into your bladder to drain your urine into a collection bag. The catheter may be left in place for one or two days. In some cases, a catheter is needed for a longer period of time. You may urinate around the catheter, which is normal because your bladder may squeeze more urine out than the catheter can accommodate. Your doctor may give you disposable catheters you can insert on your own a few times a day until you can urinate again.
• Urination may be painful, or you may have a sense of urgency as urine passes over the surgical area. You may also need to urinate more often than usual. Painful urination generally improves in one to four weeks.
• Expect some blood in your urine right after surgery. If you have clots or so much blood in your urine you can't see through it, contact your doctor.
• Your ability to resume sexual activity depends on how quickly you heal. Talk to your doctor about when it's OK for you to have sex again. You'll likely be able to resume sexual activity after a few weeks.

These steps can help you recover after your procedure.

• Drink plenty of water to flush out the bladder.
• Avoid constipation and straining during a bowel movement. Eat fiber-containing foods and avoid foods that can cause constipation. Ask your doctor if you should take a laxative, if you do become constipated.
• Don't take blood-thinning medications until your doctor says it's OK.
• Don't do any strenuous activity, such as heavy lifting, for four to six weeks or until your doctor says it's OK.

Results

In most men, TUIP improves the ability to urinate and eases related symptoms. It may be a few weeks to months before you notice the full benefits of treatment.

Your doctor will want to have regular follow-up appointments to check the condition of your prostate and to discuss any symptom changes.

If the procedure doesn't do enough to lessen your symptoms, you may need to consider additional treatment steps. A number of men who undergo TUIP need a follow-up procedure to treat prostate enlargement, particularly after several years have passed.

After TUIP, it's important to have a digital rectal exam once a year to check your prostate and screen for prostate cancer, as you would normally. If you notice any worsening urinary symptoms, make an appointment to see your doctor.