TURP - Trans-Urethral Resection of the Prostate
Transurethral resection of the prostate gland is carried out primarily to relieve obstruction. It is not the type of operation that is usually carried out in the treatment of prostate cancer. In a great majority of cases, you will be given a spinal anaesthetic or a general anaesthetic, where you go to sleep. This involves the placement of a needle into your lower back and after the injection of anaesthetic drugs you will be completely numb from the waist down. Your anaesthetist will discuss which anaesthesia will best suit you.
The Procedure:
The operation is performed by passing a telescopic instrument in through the eye of the penis and down the urethra into the area of the prostate. The internal lining of the bladder is also routinely inspected. A special electric knife is used to cut pieces of the prostate and these pieces are then sent to the laboratory for analysis. At the end of the procedure, a catheter (a plastic tube that drains urine from the bladder) is placed and usually kept in place from anything between one-three days after the surgery.
Risks of Surgery:
There is a very high success rate associated with TURP, however like any surgery, there are still risks that need to be considered. The risks of having significant bleeding are very small and it is very uncommon for anybody to require a blood transfusion. There is a small risk of developing an infection in the urine, although this risk is minimised by the routine administration of antibiotics at the time of surgery.
There is a tiny risk of being rendered incontinent which means that you would not have any control over your urine at all. This is fortunately a rare complication (less than 0.5%) and even in this unlikely event, treatment is available. Occasionally the physiotherapist may be called to help with re-toning pelvic floor muscles and occasionally medications are given to help.
There is an approximately 8-10% chance that you will lose your ability to have a penile erection and again in this event, there are very effective treatments. 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.
Post Operation:
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.
Following surgery, it is usual to have irritative urinary symptoms. In particular you can expect to have frequency of urination, urgency and initially you might even find it difficult to reach the toilet in time. It is not uncommon to see some blood in the urine for up to a couple of weeks after the operation and if you do see blood, you should increase your oral fluid intake to at least two to three litres of fluid per day (unless you have any medical reason not to do so) and you can back off on your fluid intake if your urine is clear.
If you develop excessively bright blood in your urine or experience an inability to pass urine, you should contact the Dr Bourne.
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. 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, please contact Dr Bourne. Bleeding is quite uncommon and usually happens in the first week at home if at all.
If you experience an increase in pain or if you experience severe burning and stinging in the post-operative period once home, you should contact Dr Bourne as this may be due to an 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 Dr Bourne for further consultation as treatment of this scarring is desirable.
It is critically important to avoid any activity that involves straining or exertion for at least four-six weeks. Such activities include heavy lifting (for example, grocery shopping, lifting etc). During this time you should not mow the lawn or play any sports that may involve some exertion such as golf or tennis. Driving a car should be avoided for the first two weeks.
Should you have any further questions, please do not hesitate to contact my rooms.