Having an enlarged prostate gland is part of growing older. As the prostate grows, it becomes harder for men to urinate and fully empty the bladder. This leads to more frequent and urgent bathroom trips and even sometimes overflow urine incontinence.
Fortunately, there are several effective treatment options, including medications and surgeries that can shrink the prostate and relieve urinary symptoms. The most common surgery used to treat an enlarged prostate is called transurethral resection of the prostate, also called TURP for short.
TURP has been around for a long time. It has a solid track record but can have associated side effects perioperatively. These include low sodium levels in the blood, also known as hyponatremia, as well as bleeding.
A newer version of the procedure called “button TURP” is now available. Button TURP offers men an alternative to TURP, but is it safer or more effective? Read on to learn more.
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 typically don’t have to think about their prostate until they age. Then it begins to grow, possibly due to changes in hormone production. An enlarged prostate is sometimes called benign prostatic hyperplasia (BPH).
As the prostate enlarges, it presses on the urethra, which is the tube that connects to the urinary bladder. Urine flows through the urethra on its way out of the penis. This pressure squeezes and narrows the urethral lumen and can block the flow of urine.
Doctors choose treatments for BPH based on the level of swelling in the prostate, your symptoms, and other factors. The most common treatments are:
- medication to shrink the prostate
- medication to relax the bladder neck and muscle within your prostatic urethra 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 an electrical wire loop to cut and remove excess prostate tissue.
Button TURP, also called bipolar cautery vaporization, is a newer, less invasive variation of the procedure. Instead of a wire loop on the end of the scope, the surgeon uses a device with a small, button-shaped tip to vaporize prostate tissue.
Button TURP uses low-temperature plasma energy, instead of heat or electrical energy, to remove prostate tissue. Once the extra tissue is removed, the area around it is sealed off to prevent bleeding.
Button, or bipolar, TURP is an umbrella term for a number of different treatments that aim to achieve the same overall outcome, but with different tools, techniques, or device manufactures.
Any procedure that uses an electrode “button” with bipolar vaporization is a button procedure. Innovations in the procedure involve modifying the shape of the button or making slight changes to the surgical techniques.
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 much 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 that button TURP reduces complications, like bleeding after surgery. It may also lessen the time men need to use a catheter (a tube inside the urethra in the urinary bladder) for irrigation or drainage 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 low sodium solution to keep the area clean. Because this solution can get into the bloodstream in greater amounts through the venous areas of resected prostate tissue, it can cause dilution to a below-normal sodium level in the bloodstream.
In contrast, button TURP uses a saline solution with more sodium in it than what is used in a TURP, which seems to help prevent TUR syndrome. The reduced risk of TUR syndrome allows surgeons to spend more time doing the procedure. This 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 could possibly lead to more blockages in the prostatic urethra, an area of muscle in the urethra just below the urinary bladder, but some studies show otherwise. 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
- diabetes mellitus
- a heart pacemaker
- a risk associated with blood loss (anemia) or a need to be on blood thinner 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.