Transurethral Incision of the Prostate (TUIP)

What is transurethral incision of the prostate (TUIP)?

Transurethral incision of the prostate (TUIP) is a simple surgical procedure that can relieve the symptoms of an enlarged prostate gland. The prostate gland is part of a man's reproductive system. It is normally a little bigger than a walnut. It is located between the base of the bladder and the beginning of the penis. It surrounds the upper part of the urethra. (The urethra carries urine from the bladder out through the penis.) The prostate gland produces a fluid that is ejaculated with sperm.

To relieve the symptoms caused by the enlarged prostate, the urologist (a surgeon who specializes in problems of the bladder and kidneys) makes cuts (incisions) in the prostate gland. This relieves the pressure the enlarged gland puts on the urethra.

When is it used?

When the prostate gland is enlarged it is called benign prostate hyperplasia, or BPH. BPH is usually a harmless but annoying condition that causes men to have to urinate urine often, sometimes even at night. The need to urinate can come on suddenly, which can make travel, work, and some social situations difficult or awkward. In severe cases BPH can completely block your ability to pass urine. This can cause kidney damage if not treated promptly.

TUIP is a possible treatment for men whose prostate glands are not severely enlarged. Examples of alternatives to this procedure include medicine as well as other surgical procedures, such as a transurethral needle ablation (TUNA) and transurethral resection of the prostate (TURP). Some men may choose surgery because they are unable to tolerate the medicines or the medicines are not relieving their symptoms. Ask your healthcare provider about your choices for treatment.

How do I prepare for this procedure?

Plan for your care and recovery after the operation, especially if you are going to have general anesthesia. Find someone to give you a ride home from the hospital. Although you should not expect severe tiredness or discomfort, it's always a good idea to arrange for someone to help you with meals for a day or two.

Ask for the instructions for using and caring for the catheter and the urine collection bag. It's best to learn about this before your surgery, when you are most alert and able to understand and remember the directions.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery.

On the day of surgery, do not eat or drink anything before the surgery, not even coffee, tea, or water. If you take some medicines daily, ask your healthcare provider if you should take any of your medicines before surgery. If you take blood thinners, daily aspirin, or anti-inflammatories such as ibuprofen (e.g., Motrin or Advil) or naproxen (Aleve), ask your provider if you need to stop them before surgery. If you do need to stop taking your medicines, ask your provider when you can start taking them again. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

Follow any other instructions your healthcare provider gives you.

What happens during the procedure?

You will have either general anesthesia or a spinal anesthetic. The general anesthetic will relax your muscles, put you to sleep, and keep you from feeling pain. With a spinal you are numb from the waist down. You may be awake, but you are usually given medicine to make you sleepy.

Once you are numb, the surgeon will pass a slim, lighted, flexible tube called a cystoscope into the urethra. The surgeon will make a few cuts in the prostate gland to relieve the pressure on the urethra. Once that is done, while you are still numb, a catheter (tube) will be inserted into the penis and the urethra and then into the bladder. The catheter will help the bladder drain and flush out any blood clots that may have formed. The urethra will swell after the surgery and the catheter will help it stay open.

What happens after the procedure?

When you begin to wake up, you will be moved to the recovery room. You might go home the same day you have the surgery, but it is more common to stay overnight and go home in the next day or two. You will likely have some pain or discomfort in the area over the bladder, as well as at the base of the penis. The catheter in the urethra can be irritating. It normally needs to stay in for 2 to 3 days. Do not try to remove the catheter. Your healthcare provider will remove the catheter.

Ask your provider how to care for yourself, when you can go back to work, and when you should come back for a checkup.

What are the benefits?

Many men notice that their bladder symptoms are better within 2 to 3 weeks of the surgery: They do not feel the need to urinate as often and they have few or no urination "emergencies." The improvement in symptoms tends to last a long time, but the symptoms will come back to a few men and they may need to have the procedure again after several years.

What are the risks?

The risks of complications from this procedure are low. Some possible risks include:

• There are some risks when you have general anesthesia. Discuss these risks with your provider.
• Spinal anesthesia may not numb the area quite enough and you may feel some minor discomfort. Also, in rare cases, you may have an allergic reaction to the drug used in this type of anesthesia. Spinal anesthesia is considered safer than general anesthesia.
• You may have infection or bleeding.
• Your bladder could be damaged or infected. If this causes a lot of discomfort, you may not be able to pass urine.
• Some men develop retrograde ejaculation. This means that the semen (including sperm) flows backward when you have an orgasm. Instead of being released out of the penis, it flows backward into the bladder. This is a problem only in that it may lessen the sensation of orgasm and lessen the chance of pregnancy, if that is desired.
• A few men may have problems getting erections.
• About 1 in 100 men will have incontinence, which means having trouble controlling your urine.

You should ask your healthcare provider how these risks apply to you.

When should I call my healthcare provider?

After surgery, follow your provider's instructions for taking care of yourself. If you have not been given specific instructions about when to call your provider, here are some guidelines:

Call your provider right away if:

• You are having more pain.
• You have a fever of 100°F (37.8°C) or higher.
• You are having more pink or red urine in your catheter bag than expected.
• You cannot pass urine.
• You cannot use the catheter you were given.

Call during office hours if:

• You have a question about your follow-up appointment or care.