Information regarding your Prostate Operation
These notes have been prepared for the information of patients considering prostate operations. These notes are only a general guide please ask if you have any questions.
What is the prostate gland?
The prostate is an organ found only in men. It is the size of a plum and sits below the base of the bladder. It is a spongy organ and its function is to produce a small amount of fluid from the gland into the semen during orgasm. The prostate does not produce any hormones however, so there is no change in a man’s nature or character expected after the operation.
In most men over 40 the prostate gland enlarges. Many men may not have any problems from their prostate enlarging, however, about 10-15% do require surgery to relieve their symptoms.
TYPES OF SURGERY
An operation to treat the prostate is called a “prostatectomy”. There are several types and your urologist will decide which is the best option for you. It is not always possible however to tell which operation is most suitable until you are anaesthetised and the prostate and bladder can be examined more closely.
The whole prostate gland is not removed only the part that is obstructing the urethra (water pipe). It is not a cancer operation rather a procedure for urinary symptoms.
TURP – Trans Urethral Resection of the Prostate
This is the most common form of surgery used in approximately 95% of prostatectomies. When you have been anaesthetised a telescope is carefully inserted into the penis. This allows the urologist to see the prostate and up into the bladder. The ‘scope’ has a cutting device that uses heat from an electric current and cores out the prostate. These pieces of resected prostate are sent to the laboratory for analysis. This type of operation means that you will not have any visible scar or wound following your operation.
Open Prostatectomy
When the prostate is too large to perform a TURP it needs to be removed by making a cut in the lower abdomen. The recovery period is longer because the wound needs to heal.
Bladder Neck Incision
When the prostate is not enlarged but the neck of the bladder is constricted a cut can be made into the bladder neck to open it up and improve the flow of urine.
ANAESTHETIC
Modern anaesthetics are fairly safe. The anaesthetic may be a General anaesthetic, where you go to sleep or it may be a spinal anaesthetic, where after a needle in the back, you become numb from the waist down. The anaesthetist will decide what type of anaesthetic is best for you.
RISKS
As with any operation complications can occur such as chest infections, heart attack or blood clots in the veins but these problems are rare. Problems particular to prostate surgery include: -
Bleeding
Most patients will lose a little blood during surgery. Excessive bleeding is rare but can occur immediately after the operation. Certain drugs affect blood clotting for example Aspirin and Warfarin. It is important to tell your doctor of any medications you are taking. Please see the attached important information regarding medication.
Continence
Most patients have good control of their bladder when they leave hospital. There are a few who still have some problems controlling the flow of urine. This is usually due to damage already done to the bladder by the prostate obstruction. With time, most cases improve. Occasionally the physiotherapist may be called to help with retoning pelvic floor muscles and occasionally medications are given to help.
Sexual Function
The operation can cause loss of erections in 5% of cases. However there is a 90% chance that you will experience what is known as ‘retrograde ejaculation’. This means that although the sensation will be the same at orgasm the semen will go back into the bladder and therefore not be emitted – a so called ‘dry run’. Some fluid and sperm may be delivered though so the operation is not considered a reliable contraceptive. If there have been no complication with the operation it is quite common to resume sexual activity four to six weeks afterwards.
Need for Re-operation
Prostate problems can recur but it usually takes several years if the operation was for a non-cancerous prostate. Occasionally the urethra (water pipe) may narrow after surgery, due to scar tissue, this can be corrected with a simple operation.
Before the Operation
You will be told when you need to come to hospital and if and when you need to go without food and drink prior to the operation.
After the Operation – In hospital
After the operation there is a raw surface left inside the prostate. Because this bleeds, a catheter (tube) is left in the bladder (via the penis) to drain away the blood and urine. In the post-operative stage the bleeding is often heavy and clots could form and block the catheter. Therefore a bladder washout is used to wash the blood away before clots can form. The washout is usually stopped when the patient can drink enough to keep the clots from forming. The catheter is removed a day or two later.
Most patients have an intravenous drip in their arm for a day or two after the operation. This may be used to give blood transfusions, medicines or fluids, but it is just a precautionary measure in most cases.
You will probably be able to eat and drink on the night of the operation if you have a closed operation but if have an incision it usually takes longer. As soon as possible we would like you to begin drinking a large amount of fluid. This is the single most important thing.
It is important to keep the bowels as regular and soft as possible. If you get constipated you will have to strain and this often causes the prostate to bleed more.
While the catheter is in, you do not have to pass urine yourself, the catheter will carry it away. Often it feels as though you have a full bladder, but this is usually just a ‘bladder spasm’, where the catheter irritates an overactive bladder. If you get this feeling the nursing staff will check the catheter is not blocked. These spasms although uncomfortable are harmless and should not worry you. If they are painful medicine can be given to reduce them.
When the Catheter come out.
Many patients notice some scalding and also some difficulty controlling the flow of urine. The most common problem is for the flow of urine to start with little warning therefore it is wise not to try to hold back the urine at first but go to the toilet immediately. The nursing staff will usually ask you to pass your urine into a urinal (bottle) so that they can test, measure and record it.
Results
The prostate that is removed is examined by a Pathologist and in most cases I will be able to tell you the result prior to your going home.
AT HOME
You will usually go home a day or so after the catheter is removed. If you have had an open operation, the stitches are usually taken out at about the same time. The lining of the prostate grows back and is usually completely reformed in two months.
Drinking
It is wise to continue to drink a lot of fluid for a few weeks at home – particularly if you see any blood appearing in the urine.
Activity
You should usually stay indoors for a week or so after discharge and do not indulge in any strenuous activity or heavy lifting for six weeks. Driving a car should be avoided for the first two weeks.
Bowels
It is important to keep the bowels as regular as possible, with fruit and fibre in your diet. This will avoid straining which can cause the prostate to bleed.
Bleeding
The raw surface of the prostate takes about six weeks to heal completely. In the meantime, you may pass a little scab which has fallen off the raw surface or a little blood. Do not worry about this. If however, the bleeding becomes heavy, especially if you are passing clots or get completely blocked, see your local doctor or get in touch with me. Bleeding is quite uncommon and usually happens in the first week at home if at all.
Other Problems
If you experience an increase in pain or if you experience severe burning and stinging in the post-operative period once home, you should report to your doctor as this may be due to infection which requires treating. Even after discharge an occasional patient will have a problem with narrowing of the tube due to scarring on the inside. Every patient scars differently and so it is often difficult to predict. If you experience a decrease in your stream or any other symptoms even up to one year after the operation, please do not hesitate to return immediately to your GP or to myself for further consultation as treatment of this scarring is desirable.
CONCLUSION
This is not intended to be an exhaustive summary of prostate disease and its treatment. Please do not hesitate to talk to your doctor if you have any questions or concerns.
PLEASE READ THE IMPORTANT INFORMATION BELOW REGARDING MEDICATION
Stop the following TWO WEEKS prior to admission:-
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Stop the following SEVEN DAYS prior to admission:-
Anti-inflammatory drugs:
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ANTICOAGULANTS
If you are taking MAREVAN, DINDEVAN OR WARFARIN, TICLID, TICLOPIDINE, COUMADIN take half dose for ONE day, FIVE days before the operation, then stop the tablets FIVE days before the operation. Discuss this with your Physician, as some patient Need Heparin injections when they cease taking these tablets. The tablets should not be resumed until TWO weeks after the operation, unless otherwise advised by your Physician or Surgeon.
Panadol, Panadeine or Digesic may be taken for pain relief.
PLEASE ENSURE DOCTOR IS AWARE OF ALL DRUGS, PILLS, MEDICATIONS ON OR OFF PRESCRIPTION THAT YOU TAKE, EVEN IF THEY ARE NOT ON THE ABOVE LIST.