A significant number of men with an enlarged prostate gland may require some form of surgical intervention.
These methods have proven effective in treatment and disease management. But they often cause damage to nearby tissues, leading to significant side effects such as urinary complications and erectile dysfunction.
In the last decade, several minimally invasive procedures have proven helpful in reducing side effects associated with the invasive methods.
Here, we explore the benefits of minimally invasive prostate surgery and the available data on their efficacy and safety. We offer information to help you consider the best treatment for your specific disease.
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Invasive vs. minimally invasive prostate surgery
There are many approaches for treating prostate conditions, and not all of them involve a significant trauma to the body. This option is vital for men who are concerned about the side effects of surgical treatment.
When using surgery to treat a prostate condition, invasive methods use a larger incision on the abdomen to access the pelvic region and operate on the prostate gland.
In contrast, minimally invasive approaches use various techniques to operate on the prostate with minor damage to the body. Typically, doctors can complete these procedures through tiny cuts or tube-style instruments inserted into you.
Common invasive prostate surgeries include transurethral resection of the prostate, open prostatectomy, and robotic prostatectomy. They are the current gold standard surgical intervention for troublesome benign prostatic hyperplasia (BPH) or localized prostate cancer.
However, these methods are also associated with considerable side effects, such as urinary incontinence and erectile dysfunction, all of which reduce the patient’s quality of life. Because of these adverse effects, scientists have developed a range of minimally invasive techniques to help reduce the risk of adverse side effects.
Some of the minimally invasive surgical techniques used to treat prostate conditions include transurethral needle ablation, transurethral microwave thermotherapy, high-intensity focused ultrasound, transurethral electrovaporization, water-induced thermotherapy, Urolift, and prostate artery embolization.
With these newer techniques, the body does not have to heal from large wounds, reducing the risk of adverse treatment effects.
The following sections will discuss what these procedures involve and provide some details about their efficacy.
Why choose minimally invasive prostate surgery?
Minimally invasive prostate surgery causes less damage and stress to the body. By definition, all surgery is invasive and will cause some damage both to the affected prostate tissue and surrounding normal tissue.
However, less invasive surgery offers many benefits and is more targeted compared to traditional surgical techniques. They offer patients smaller wounds, faster recovery times, reduced pain and scarring.
Smaller surgical wounds
The most significant benefit of this type of surgery is the size of the surgical cut or lack of it.
Unlike invasive prostate surgery, which requires large incisions to reach the prostate gland, minimally invasive surgery relies on tiny incisions or through the urethra to insert tubes, cameras, or small surgical tools.
The size of the cuts enables you to heal faster and have fewer scares than traditional surgeries.
Reduced complications
Complications typically affect only a tiny region of healthy tissue around the pelvic area. This benefit can help reduce urinary and sexual problems.
Reduced pain
This aspect is related to the size of the incisions. Fewer cuts mean that the procedures cause less pain and discomfort at recovery stages.
Studies have shown that patients recovering from minimally invasive interventions report less pain and require fewer pain relievers than conventional prostate surgery.
Reduced hospitalization
With reduced healing time, pain and complications, patients should expect to go home faster. In many cases, men who undergo these procedures are likely to return to normal activities quicker.
Increased accuracy
This type of surgery also increases the accuracy rate compared to invasive surgery. This benefit derives from the fact that the techniques either use a camera or target specific internal organs.
Overview
In many cases, performing less invasive prostate surgery is a better option for the patient. Thus, most surgeons and patients prefer a minimally invasive treatment if it is an option.
However, it is essential to note that they are not inherently better than invasive procedures in every situation.
In particular, these procedures may not treat the symptoms to the same level or durability as the invasive options. Thus, your doctor may recommend an open prostatectomy as the safest way to treat your prostate condition.
Further, your surgeon may switch to a more invasive approach during these minimally invasive procedures to ensure your safety and effective treatment.
Despite the above caveats, men who underwent minimally invasive approaches to treat their prostate conditions recover faster, experience less pain, and have fewer complications.
Your doctor will help you determine the best treatment option based on your clinical presentation, overall health, and previous treatments.
Types of prostate surgery
Researchers have made several notable attempts to develop effective minimally invasive methods to treat prostate conditions. The standard techniques are as follows.
Transurethral incision of the prostate (TUIP)
This is a procedure that involves cutting small groves at the junction of the prostate and bladder (bladder neck) (Foster et al., 2018). The doctor performs this procedure using a resectoscope inserted through the penis to the urethra. Although it is recommended for men with small prostate, its efficacy is similar to TURP (Lourenco et al., 2010).
However, men who undergo this procedure have a lower risk of bleeding and dry ejaculation than prostate resection or open prostatectomy (Foster et al., 2018). Possible side effects associated with TUIP include difficulty urinating, infection, and the need for retreatment.
Transurethral needle ablation (TUNA)
This removes prostatic tissues by delivering a low radiofrequency power through a small urethral catheter inserted through the penis (Schulman and Zlotta, 1994).
It has been shown to improve clinical outcomes over 5-year monitoring, and most men do not require additional BPH treatment in the long term (Zlotta et al., 2003).
However, it increases the risk of developing long-term prostate irritation and inflammation that may need more invasive surgery to resolve.
Transurethral microwave thermotherapy (TUMT)
This procedure removes prostatic tissues by delivering microwave energy through a urethral catheter (Hoffman et al., 2012). TUMT is an effective alternative to alpha-blockers for shrinking the prostate gland, especially in men with larger prostate glands (Hoffman et al., 2012).
It is more suitable for men with no history of urinary retention or other prostate surgeries because of its associated risk of urinary retention (Hoffman et al., 2012).
Importantly, it has lower chances of retrograde ejaculation and transurethral resection syndrome compared to invasive surgery.
However, the pain and infection associated with urinary retention may require retreatment.
High-intensity focused ultrasound (HIFU)
High-intensity focused ultrasound destroys prostatic tissues by focusing ultrasound beams through a probe inserted into the rectum.
It can ablate prostate tissues with minimal damage to surrounding healthy tissues (Lü et al., 2007). Men who received HIFU reported low rates of complication (Chaussy and Thüroff, 2001).
Transurethral electrovaporization (TUEVAP)
This option vaporizes prostate tissue by heating a ball inserted through the urethra.
Unfortunately, there is no significant difference in early postoperative morbidity or recovery time between TUEVAP and surgical prostate resection (McAllister et al., 2003).
Water-induced thermotherapy (WIT)
WIT circulates heated water through a catheter to target thermal energy to the prostatic tissue. WIT takes less than 1 hour to complete and has been shown to cause fewer side effects than other methods (Cioanta and Muschter, 2000).
Urolift
Urolift uses implants inserted into the prostate to pull it away from the urethra, improving urine flow. It does not have the complications associated with thermal or surgical methods (Roehrborn, 2016). Erectile dysfunction is rare, but men may require further treatment if the prostate continues to enlarge.
Prostate artery embolization (PAE)
Prostate artery embolization uses a special dye to identify prostate blood supply and blocks them to starve the prostate gland.
Though there is still a lack of published long-term data on PAE, reports from short and mid-term studies show a beneficial safety profile.
Like other minimally invasive techniques, relief of urinary symptoms is less intense after PAE than more invasive techniques (Vigneswaran et al., 2021).
Because doctors perform PAE through the vessels instead of the urethra, it has no upper limit on prostate size, and causes less severe urinary and sexual complications.
However, due to various reasons, the failure rate is still high and requires further invasive treatment (Christidis et al., 2017).
Rezum
This procedure uses water vapor to target thermal energy to the prostatic tissue, reducing prostate size through heat-induced cell death.
It has beneficial efficacy and safety profiles, which remain durable after several years (McVary et al., 2016a, 2019).
Relatively low risk of sexual complications is a noteworthy feature of Rezum (McVary et al., 2016b).
Minimally invasive prostate surgery
The problem with almost all of procedures is that they damage the prostate and therefore cause short or even long-term consequences euphemistically referred to as side effects.
The only difference between them is that they use different technologies but it doesn’t matter how you damage the prostate, it is damage. Exceptions to this are uro lift since it just relieves pressure on the urethra but even that is still invasive.
Of all the procedures that cause damage to the prostate probably rezum causes the least amount of damage.
The only truly minimally invasive procedure which does not damage the prostate is prostate artery embolization.
Things to consider when choosing surgery
Surgery is a critical tool in the treatment of prostate conditions, including burdensome BPH. It reduces urinary symptoms of BPH and the risk of sustained prostate enlargement.
The success rate for surgery to treat prostate enlargement, with most men making a full recovery within months after surgery.
Unfortunately, all types of surgery are associated with side effects.
Common side effects often observed after surgeries
The type and severity of these adverse effects will depend on the exact intervention you receive.
Typically, minimally invasive techniques have fewer and less severe side effects compared to their invasive counterparts.
Some side effects are short-lived, while others persist for many years after surgery. Discuss with your doctor to help you identify the best treatment for your specific prostate condition.
Urinary complications
Urinary complications including painful urination, difficulty urinating, and urinary incontinence are common after surgery.
Most prostate cancer patients treated with any form of surgery will experience one or more of these effects to different degrees. They will usually improve after some weeks.
In some men, surgery-related urinary incontinence can persist for many years.
Erectile dysfunction
Difficulty getting and maintaining an erection is frequent after surgery. An injury to the nerves that control erection increases the risk of developing long-term erectile problems.
Retrograde ejaculation and infertility
Retrograde ejaculation and male infertility occur in more than 90% of cases.
Lymphedema
Surgery can damage lymph nodes around the prostate gland, causing swelling and pain.
Conclusion
Depending on the severity of your symptoms, several treatment options for BPH are available.
You may receive watchful waiting, drug therapy, or surgical interventions, including invasive and minimally invasive techniques.
Radical prostatectomy is the standard of care but can increase your risk of developing impaired sexual function as well as urinary tract infection. Fortunately, Urolift, PAE, and Rezum can reduce the rate of these complications.
However, the gentle techniques utilized by these alternative methods leave most of the prostate gland untouched, making it possible for BPH and symptoms to recur.
Therefore, it is essential to consult your doctor on the risks and benefits of the different approaches to treat your prostate condition.
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