Urology Lead To Less Invasive Procedures
February 24, 2005
By Jeffrey Lee
As a urologist, I deal with
disorders of the male and female urinary and genital
systems. Rapid advances in the field of urology have
resulted in improved care for patients. There is a
trend toward minimally invasive treatments. This
article will focus on two such treatments. One of
these is a new minimally invasive treatment for
prostate problems. The other is a less invasive type
of vasectomy. Both procedures are performed In the
The prostate is a
walnut-shaped gland that sits below the bladder and
wraps around the urethra in men. BPH is benign
prostatic hyperplasia, a noncancerous enlargement of
the prostate. As the prostate grows it can restrict
the flow of urine from the bladder by squeezing the
urethra. BPH usually occurs in men over age 50 and
affects millions worldwide.
BPH symptoms include the
need to urinate more often, especially at night;
urgency or the sudden sensation that you will wet
yourself; a sensation of incomplete emptying of the
bladder; a weak urine stream; and the need to strain
or push when beginning to urinate. BPH symptoms can
cause discomfort, embarrassment, sleep disruption or
unwanted lifestyle changes. If the symptoms are
allowed to progress, more severe consequences may
ensue. These include urinary tract infections, blood
in the urine, bladder stone formation, the inability
to urinate and kidney failure.
BPH can be diagnosed by your
physician. BPH and its symptoms have historically
been treated with medications or surgery. The drugs
either loosen up the tightness of the prostate or
shrink it down in size. Medication therapy may not
be effective and can have side effects limiting its
tolerability. Medication expense is also a factor
for many patients. Surgery can consist of TURP or
transurethral resection of the prostate. Here an
instrument is passed into the urethra and
electrocautery is used to scrape out pieces of the
prostate to create an open channel. Various lasers
may also be utilized to treat BPH. Surgery involves
a hospital stay, recuperation and the possibility of
This is where an exciting,
minimally invasive one time treatment for BPH comes
in – TUNA (Medtronic Corporation, Shoreview, Minn).
TUNA, which stands for transurethral needle ablation
of the prostate, is a nonsurgical treatment for
symptomatic BPH. The procedure is performed
in-office with a local anesthetic. The TUNA device
is inserted into the urethra to deliver low-level
radio frequency energy directly into the prostate.
This energy shrinks and destroys the prostate
tissue, relieving the constriction on the urethra
and improving symptoms of BPH.
The procedure usually takes
less than 30 minutes. Most TUNA patients quickly
return to normal daily activities. Generally,
patients see improvements in their symptoms in two
to six weeks. Improvements may continue over two to
three months. Sexual side effects, such as impotence
and ejaculation problems, are extremely rare.
Incontinence with TUNA has not been reported.
Vasectomy is a minor
surgical procedure to cut and close off the tubes
(vas deferens) that deliver sperm from the testes;
it is usually performed as a means of contraception.
Vasectomy is nearly 100-percent effective, safe and
does not interfere with sexual pleasure.
Urologists perform vasectomy
procedures. A number of techniques are available.
One that has grown in popularity with doctors and
patients is the No-Scalpel Vasectomy (NSV). Both the
traditional method and the no-scalpel technique are
performed in the doctor’s office, under local
anesthetic, and are safe and effective in
The traditional vasectomy is
a minor surgical procedure and is usually completed
in under 30 minutes. The surgeon uses a scalpel to
make one or two incisions in the skin of the scrotum
to access and expose the tiny vas deferens tubes
from each testicle. The vas delerens is lifted, cut,
tied, clipped, a section removed and often
cauterized. The cut tubes are returned to the
scrotal sac and the incisions are closed with a few
In the early 1970’s a new
procedure known as “no-scalpel vasectomy” was
developed in China by Dr. Li Shunqiang. Key to NSV
are the special instruments that allow the procedure
to be done with less manipulation of the patient’s
tissues. A surgical clamp is used to hold the vas
deferens while a puncture is made in the skin of the
scrotum with special forceps. The forceps are opened
to stretch the skin, making a small hole through
which tile vas deferens is lifted out, cut, tied,
clipped, a section removed, cauterized and then put
back in place. The puncture does not require
suturing. Some urologists recommend the no-scalpel
method because they find it is quicker and minimizes
postoperative discomfort and the risk for bleeding
and infection. This results in faster recovery.
Recently, as encouraging studies are reported, more
vasectomies are being performed using this approach.
During the past few decades, over 15 million
no-scalpel vasectomies have been performed.
If you would like more
information about the TUNA procedure, no-scalpel
vasectomy, or other urologic issues, call Dr.
Rosenblum at 610-594-5444, toll-free 877-MD-URINE,
or visit www.rosenblumurology.com.