Transurethral Incision of the Prostate (TUIP)
Transurethral incision of the prostate (TUIP) is a procedure healthcare providers use to relieve urinary symptoms of a mild or moderately enlarged prostate. During TUIP, a provider makes one to two cuts (incisions) into your prostate near your bladder. This relieves pressure and urinary symptoms, like leaking pee and difficulty peeing.
Transurethral incision of the prostate (TUIP) is a treatment for benign prostatic hyperplasia (BPH), or an enlarged prostate. During TUIP, a healthcare provider uses a laser or electric current to make one or two cuts (incisions) in your prostate where it meets your bladder (bladder neck). This frees the opening of your bladder and allows it to drain pee (urine) better, relieving symptoms of an enlarged prostate.
Your provider performs the procedure using a thin tube called a resectoscope that reaches your prostate through your urethra (the tube that drains pee to the outside of your body, through your penis).
Providers use TUIP if you have a moderately enlarged prostate blocking your flow of pee. This might cause urinary symptoms like difficulty peeing and leaking pee (urinary incontinence).
You might get TUIP instead of other BPH treatments if:
- You’re concerned about side effects that might affect your fertility.
- Other treatments are risky or otherwise less preferable for you, because of other health conditions or concerns you have.
- You and your provider think a minimally invasive treatment is the best option.
TUIP and TURP (transurethral resection of the prostate) both treat BPH. TURP is a surgery that cuts away and removes parts of your prostate. TUIP treats BPH with incisions in the prostate, but without removing any of it.
Your provider will give you instructions on how to prepare for TUIP. Following their directions closely can reduce your risk of complications. Before TUIP, your provider may ask you to:
- Not eat anything for eight hours before the procedure (fast).
- Stop taking medications before the procedure or take them with just a sip of water. Don’t stop taking medications unless your provider tells you to.
- Arrange for someone to drive you home after the procedure.
Just before a TUIP procedure, your provider may give you general or regional anesthesia. If you get general anesthesia, you’ll be asleep for the procedure. If you get regional anesthesia, you’ll be awake, but the lower half of your body will be numb.
To perform TUIP, your surgeon will:
- Insert the resectoscope into your prostate through your urethra.
- Make one or two small incisions in your prostate.
- Remove the resectoscope and insert a urinary catheter (also known as a Foley catheter). This drains your pee and other fluids from your bladder and prevents blood clots. A provider will remove it in a few days.
The TUIP procedure itself takes about 30 to 45 minutes. If you’re not staying at the hospital, you’ll be monitored at your provider’s office for an hour or more afterward before you can go home. Some people may need to stay overnight for a day or two after the procedure.
Advantages of TUIP include:
- It’s an alternative to other BPH treatments that some people can’t or don’t want to undergo due to additional health concerns.
- It’s less invasive than TURP.
- It’s less likely to cause side effects that affect your fertility, like retrograde ejaculation (orgasm without ejaculating).
Risks and disadvantages of TUIP include:
- Erectile dysfunction (ED).
- Retrograde ejaculation. While it’s less likely to happen than with TURP, about 18% of people who have TUIP experience retrograde ejaculation.
- Urinary tract infections (UTIs).
- Scar tissue in your bladder that makes it hard to pee (bladder neck contracture).
- Urinary incontinence.
- Narrowing of your urethra (urethral stricture).
- Additional treatment. People who undergo TUIP are more likely to need an additional surgery within a few years than people who get TURP.
About 83% of people who have TUIP for mild to moderate prostate enlargement see symptom improvement.
It can take three to five weeks to fully recover from a TUIP procedure. You might not notice symptom improvement for a few weeks or months afterward.
For a few days to a week, you may notice:
- Blood in your pee.
- Urgent need or frequent need to pee.
- Burning or pain while peeing.
While recovering, it’s important to:
- Take any medications as prescribed. Your provider may prescribe antibiotics to help prevent a UTI after the procedure.
- Follow your provider’s instructions for caring for your Foley catheter.
- Drink plenty of water every day.
- Avoid heavy lifting and exercising. Ask your provider what level of activity is OK.
- Avoid bike riding.
- Avoid hot baths and saunas.
When should I call my healthcare provider?
Contact your provider if you have any questions before or after your procedure. Let them know right away if you have:
- Fever.
- Cloudy or foul-smelling pee.
- Unexpected or severe pain.
- Excessive amounts of blood in your pee.
References
- DuBeau CE, Ortengren CD. Benign Prostate Disorders. In: Halter JB, Ouslander JG, Studenski S, et al, eds. Hazzard’s Geriatric Medicine and Gerontology. 8th ed. McGraw Hill; 2022.
- Elkoushy MA, Elshal AM, Elhilali MM. Holmium laser transurethral incision of the prostate: Can prostate size predict the long-term outcome? (https://pubmed.ncbi.nlm.nih.gov/26316907/) Can Urol Assoc J. 2015 Jul-Aug;9(7-8):248-54. Accessed 6/11/2024.
- Foster HE, Barry MJ, Dahm P, et al. Surgical Management of Lower Urinary Tract Symptoms Attributed to Benign Prostatic Hyperplasia: AUA Guideline (https://pubmed.ncbi.nlm.nih.gov/29775639/). J Urol. 2018 Sep;200(3):612-619. Accessed 6/11/2024.
- Lourenco T, Shaw M, Fraser C, MacLennan G, N’Dow J, Pickard R. The clinical effectiveness of transurethral incision of the prostate: a systematic review of randomised controlled trials. (https://pubmed.ncbi.nlm.nih.gov/20033744/) World J Urol. 2010 Feb;28(1):23-32. Accessed 6/11/2024.
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