(Trans-Urethral Resection of the Prostate)
No special preparation for the surgery (i.e. shaving or diet) is required. You will usually come in on the day of the operation and should starve for at least six hours prior to the scheduled operating time.
If you are taking aspirin it is advisable to stop it for two weeks prior to the operation, as there is a slightly increased risk of postoperative bleeding.
The operation is carried out under spinal (awake but numb from the waist down) or general (asleep) anaesthetic. SUrgeons may recommend spinal anaesthesia for a number of reasons including reduced postoperative discomfort and less chest infection risk. It is also usually interesting for patients to see their surgery being performed although this is not compulsory! In general however it is the patient's choice as to the type of anaesthesia.
Under anaesthetic a telescope is passed into the bladder. The decision is then made as to whether removal of some of the prostate or a simple cut is best. This is accomplished by a very high powered electric knife, passed through the telescope, which vapourises the tissue. Any chips of prostate tissue are washed out and a second type of electric current used to stop bleeding. A 3 way catheter (plastic drainage tube) is then placed in the bladder to drain the urine and allow any bleeding to be washed out.
Following the operation it is usual to have mild discomfort. The majority of men will need only simple painkillers, but as in any surgery there may be more discomfort requiring strong painkillers or drugs to calm bladder spasm.
One should try to remove the catheter early as this reduces the risk of urinary infection and penile discomfort after the operation. This may be on the first day after the operation, but in bigger prostates and if a catheter was in place before the operation may take longer.
Once the catheter is removed and the patient passes water he can usually leave hospital.
Despite the absence of a cut in the skin, this is still classified as a major operation. There may be bleeding at the time of surgery or later: the necessity for blood transfusion is around one in thirty. Advances in anaesthetic techniques reduce the risk of serious chest infection.
Some men may fail to pass water after the operation: this is much more common if the surgery is being done where the bladder has been stretched or is emptying poorly and this would be discussed with you in detail. In men with good bladder emptying there is still a possibility of around on in twenty of some difficulty passing urine after the catheter is removed: this may require a short period with a small soft catheter to rest the bladder but has no long term ill effects and does not require prolonged hospitalisation.
The major side effect is of retrograde ejaculation, which is when the semen falls back into the bladder instead of coming out through the penis. It occurs in most men who have removal of prostate tissue and about one in five who have a BNI. Some men may feel the orgasm to be somewhat less intense if this happens, but usually learn to appreciate the sensations again. Retrograde ejaculation may cause sterility but cannot be relied upon as a form of contraception since some sperms nay still be expelled.
In a small number of men impotence is reported after the operation. While some studies have suggested up to one quarter of men being affected by this problem following TURP, the numbers here are probably no more than five per cent if the operation is well done in a man with no pre-existing erectile dysfunction. Treatment with Viagra or other drugs may be of benefit should this occur.
If urgency and getting up at night are major problems prior to the operation, or of there is any history of incontinence, I usually recommend a urodynamic examination to confirm that obstruction is present. Despite this about one man in six with these symptoms may find they persist post operatively, due we presume to a primary overactivity of the bladder. If this does happen there are medical treatments which will usually help.
Since not the entire prostate is removed, regrowth can occur. The figures suggest that one man in four will need revision surgery over a ten-year period due to prostate regrowth.
Lastly, incontinence may rarely occur. The reported incidence is around one per cent. Pelvic floor exercises, which I recommend in the recovery period, may strengthen the muscles around the prostate and speed a return to full continence.
The bladder will often be overactive for a few weeks after the operation, giving a sense of things getting worse before getting better. It is thus sensible to avoid any long journeys after the procedure for a few weeks. Bladder function can keep improving for up to four months after the procedure.
Bleeding is common after the operation, particularly in the first few days and then again after a few weeks (this is probably linked to the scab separating from the wound). If bleeding is a major problem then it is important to drink well and to have a urine sample checked to rule out urinary infection.
It is sensible to avoid heavy lifting and driving for three weeks after the operation since any sudden increase in abdominal pressure can cause bleeding to occur.
You can return to work when you feel fit and depending on your job: usually three or four weeks off are needed.
Sexual intercourse is usually avoided three weeks or so. On resumption of intercourse, if you do ejaculate normally, it is likely there will be blood or discolouration of the semen. This is nothing to worry about and will not harm your partner in any way.
After any surgery you may feel tired and a bit emotional for a number of weeks. This is quite normal, but if you feel depressed it is important to let someone know.
Copyright (c) 1999-2001 GH Muir. All rights reserved.