An enlarged prostate is part of growing older. As the prostate grows, it becomes harder to urinate and fully empty the bladder, which leads to more frequent and urgent bathroom trips.
Fortunately, men have several effective treatment options, including medications and surgery, to shrink their prostate and relieve urinary symptoms. The most common surgery used to treat an enlarged prostate is called transurethral resection of the prostate, or TURP.
TURP has been around for a long time, and it has a solid track record but can have side effects. These include low sodium levels in the blood, also known as hyponatremia, as well as bleeding.
In recent years, a newer version of the procedure called “button TURP” has become available. Button TURP offers men an alternative to TURP, but is it safer or more effective?
The prostate is part of a man’s reproductive system. This walnut-sized gland sits between the bladder and pelvic floor muscles in front of the rectum. Its job is to produce fluid that mixes with sperm to form semen during ejaculation.
Men don’t usually have to think about their prostate until they age. Then it begins to grow, possibly because of changes in hormone production. An enlarged prostate is sometimes called benign prostatic hyperplasia (BPH).
As the prostate swells, it presses on the urethra, the tube that urine flows through on its way out of the penis. This pressure squeezes the urethra and can block urine flow.
Doctors choose treatments for BPH based on how much a man’s prostate has swelled and his symptoms. The most common treatments are:
- medication to shrink the prostate
- medication to relax the bladder neck and prostate muscles to make urinating easier
- surgery to remove extra prostate tissue
The most common surgery for BPH is TURP. During this procedure, the surgeon inserts a well-lighted scope into the urethra and uses a wire loop or laser to cut and remove excess prostate tissue one piece at a time.
Bipolar cautery vaporization, or button TURP, is a newer, less invasive variation of the procedure. Instead of a wire loop or laser on the end of the scope, it uses a small, button-shaped device to vaporize prostate tissue.
Button TURP uses low-temperature plasma energy, instead of heat, to remove prostate tissue. Once the extra tissue is removed, the area around it is sealed off to prevent bleeding.
Button TURP appears to be just as effective as traditional TURP at shrinking the prostate. A few studies have hinted at some advantages of this newer procedure, but there isn’t a lot of long-term evidence to prove that it’s any better than regular TURP.
One theoretical advantage of button TURP is that all the energy stays inside the device. In regular TURP, the electric current can leave the wire and damage tissues around the prostate.
Some studies have found button TURP reduces complications, like bleeding after surgery. It may also shorten the time men have to use a catheter (a tube to remove urine) after surgery. Yet other studies have found no difference in complication rates.
One post-surgery problem button TURP does seem to prevent is a rare but very serious condition called TUR syndrome. During TURP, the surgeon washes out the surgical area with a solution to keep the area clean. Because this solution is low in sodium, if it gets into the bloodstream, it can cause low sodium levels in the body. Button TURP uses a saltwater (saline) solution, which seems to prevent TUR syndrome. The reduced risk of TUR syndrome allows surgeons to spend more time doing the procedure, which ideally means they can work on larger prostates or perform more complex surgeries with button TURP.
Button TURP doesn’t seem to have many more disadvantages than traditional TURP. It may lead to more blockages in the bladder neck, an area of muscle between the bladder and urethra. This type of blockage can make it harder to urinate normally and empty the bladder fully.
Discuss with your doctor whether you’re a good candidate for button TURP. This procedure might be an option if you have:
- an especially large prostate
- a heart pacemaker
- a risk of blood loss, especially if you’ve been on long-term aspirin therapy
Talk to your doctor about all of your treatment options. Ask about the pros and cons of each based on your situation. Then you can decide together whether button TURP is the best choice for you.