Transurethral incision of the prostate: a viable alternative to transurethral resection

TUIP has been shown to be an effective method of relieving urinary outflow obstruction caused by BPH when prostatic size is 30 g or less. This is the situation for approximately 80% of patients undergoing TURP today. The long-term results of TUIP are quite favorable when compared with those of TURP. It is an easier technique to master than TURP. In addition, TUIP has a reduced operative time, little intraoperative and postoperative hemorrhage, reduced incidence of dilutional hyponatremia (TUR syndrome), and decreased length of hospitalization. TUIP also offers a lower risk of complications, especially with regard to impotence and retrograde ejaculation. This makes TUIP particularly well suited for patients in whom maintenance of sexual function is an important consideration. TUIP is also indicated in chronically ill, debilitated patients in whom the risk of anesthesia-related complications is high. Orandi and Graversen et al have shown that TUIP can be satisfactorily performed using only local anesthesia in high risk patients. However, TUIP is not without disadvantages. It is not effective for patients with a prominent median lobe or those with a markedly enlarged prostate gland (greater than 30 g). Another disadvantage is that no tissue is obtained for pathological analysis. Thus, all patients undergoing TUIP should be evaluated preoperatively with both a serum prostate-specific antigen determination and a meticulous digital rectal examination. As cost containment becomes a key factor for our health care system, it is quite likely that TUIP, as well as other less invasive procedures, will have expanded indications. Although the role of TURP in the management of very large prostates causing bladder outlet obstruction is not in question, smaller glands might be better managed with such a treatment as TUIP. As indicated earlier in this report, 80% of patients undergoing TURP could be effectively treated with TUIP--a less invasive, more cost effective treatment that has fewer associated side effects than TURP. Without question, TUIP is a grossly underutilized procedure in 1992. However, its future appears bright as more urologic surgeons are becoming aware of its many advantages and excellent long-term results.