Transurethral incision of the prostate (TUIP)

Transurethral incision of the prostate (TUIP) is a minimally invasive surgical procedure in men. It is done in mildly enlarged prostate of men with urinary symptoms. This is done in young men whose prostate is not enormously enlarged. Small cuts are made to relieve the symptoms of pressure on the prostate. 

Anatomy:

The prostate is a reproductive organ in males located in the lower part of the pelvis in males. It is present between the penis and the urinary bladder. It looks like a cone and has five lobes. It produces fluid that keeps the sperm healthy. A prostate-specific antigen that plays an important in the male fertility and motility of the sperm is secreted by it. 

Benign prostate hyperplasia (BPH):

BPH is a condition of the prostate. It commonly affects the older age group. It causes an increase in the size of the prostate. This enlarged prostate can pressurize the urethra narrowing it. This causes many symptoms like increased urge to urinate at night, increased frequency of urination, and inability to empty the bladder. 

Technique:

TUIP is a minimally invasive surgery done for mild enlargements of the prostate. A special instrument called the resectoscope is inserted through the penis into the urethra. Small cuts are made in the junction of the prostate and the urinary bladder so that more space is created for easy urinary flow. 

Indications:

TUIP is indicated in mild BPH. It is done to reduce the symptoms of BPH like increased frequency of urination, urge of urination, difficulty in starting to urinate, prolonged urination, increased frequency of nighttime peeing, discontinuous flow of pee, inability to empty the bladder, and frequent urinary tract infections. 

Additional disease conditions where TUIP is indicated are kidney or bladder damage, stones in the bladder, and blood in the urine. 

Advantages:

There are many advantages of TUIP.

• It is a very safe, efficient, and minimally invasive procedure in men with small enlargements
• It has a low risk of bleeding and is safe in individuals who use blood thinners or who have bleeding disorder 
• It can be done as an outpatient procedure and needs less hospital stay 
• There is less incidence of the backflow of semen into the bladder during ejaculation
• Erectile dysfunction, a condition of the penis, is less with TUIP than with other procedures
• This procedure has relatively fewer adverse effects due to the procedure
• It takes less time than any other surgical procedure for BPH
• Catheterization time is also less
• It is simple and cost-effective 
• It is advantageous over open prostatectomy and transurethral resection of the prostate

Before the procedure:

Before TUIP, it is important to understand the importance of the procedure by discussing it with the healthcare provider (HCP). Complete details regarding the medical, surgical, allergic, and medication history should be given to the HCP. Diet will be restricted and a list of medications to be stopped and another list of medicines to be used before the procedure will be given. One has to undergo certain blood tests to understand the current medical condition.

 Certain advanced imaging studies like MRI or CT is also done to assess the extent of the disease. TUIP will be done on an empty stomach under anesthesia. Hence it is necessary to refrain from eating anything 8-12 hours before the procedure. Inform the healthcare provider of any previous allergies to anesthesia. 

During the procedure:

TUIP is done under general anesthesia or it may be done under spinal anesthesia. Spinal anesthesia blocks the sensation and pain from below the waist. Local anesthesia will be given through the urethra and the prostate by a gel or an injection. 

A special instrument called the resectoscope is used in this procedure. It has a lens or a camera, a cutting edge, and a few valves. It is inserted in the penis and sent from the penis tip till it reaches the prostate. One or two cuts are made on the inside of the prostate at the junction of the prostate and the bladder. This area is called the bladder neck and it releases the pressure on the bladder. 

A hollow tube called the catheter I placed in the bladder to drain the urine. It is also used for repeated flushing of the bladder and urethra with a sterile solution to prevent clots. TUIP takes about half an hour. 

After the procedure:

After the procedure, the individual is monitored till the vitals stabilize. Medications are given to reduce pain and ward off infection. About 1-3 days after the procedure, the catheter is removed. One can resume normal activities in three days but should avoid strenuous activities for at least two weeks after the procedure. One can have sex about four weeks after the procedure. Pelvic floor exercises should be started to increase control over the pelvis area. 

Effectiveness:

TUIP is an effective procedure in males with prostate enlargement of less than 30g. It can decrease the signs and symptoms of BPH

Side effects:

Certain side effects include blood in the urine for a few days after the procedure. Frequent urge to urinate, burning sensation at the tip of the penis, and at the end of urination are some of the side effects. One may also experience a loss of control over the bladder for a few days. 

Risks and complications:

Certain risks associated with the procedure include recurrent urinary tract infections due to catheter placement, erection difficulties in those who did not have it prior, and recurrence of the symptoms needing another treatment. 

Conclusion:

TUIP is a safe and effective procedure for benign prostate hypertrophy. It works on the principle of cutting the excess prostate using a resectoscope. It causes less difficulty in faster recovery and improved quality of life.

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