TRANSURETHRAL INCISION OF THE PROSTATE (TUIP)

What Happens

In terms of anesthesia, recovery, and mode of access to the prostate, this procedure is similar to the TUR: An instrument called a resectoscope lights the way for surgeons to see the prostate; the resectoscope is threaded through the urethra, so no skin incision is needed. The difference is that, instead of removing the excess prostate tissue, surgeons just make two tiny longitudinal cuts in it. (See figure io.i.) These incisions extend from the bladder neck down into the prostate, and they break the ring of tissue’s stranglehold on the urethra— giving it “breathing room.” Like the TUR, this procedure is preferable for men whose prostates are not grossly enlarged, and is the procedure of choice for men in whom the prostate is smaller than thirty grams, or one ounce.

It is also better suited to younger men, mainly because of one key advantage: The TUIP is more likely to preserve normal ejaculation than TUR. (This has nothing to do with sexual function or performance; it means simply that these men are more likely able to father a child. Otherwise, there’s no noticeable difference in orgasm between the two procedures.) Men who undergo TUR report a slighdy better urinary flow rate than men getting the TUIP procedure. And it’s not certain whether the effects of TUIP last as long as those of TUR The re-operation rate is about the same for both procedures, about i to 2 percent a year.

One concern with TUIP is that it produces no resected tissue chips—and thus, no way of checking for prostate cancer; some doctors recommend going ahead and performing a biopsy of the prostate during this procedure, as long as they’re “in the neighborhood.” The average hospital stay for TUIP is one to three days.

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