Your Urologist has recommended that you have an operation of the prostate called a Transurethral Resection of the Prostate, or TURP. This procedure is often necessary to relieve the symptoms of an enlarged prostate when other less invasive means to improve your urine stream have failed. This brochure is designed to supplement the information presented to you in the office about the operation.
THE PROSTATE GLAND
The Prostate gland is a structure that surrounds the urethra (the urine passageway) and lies at the base of the bladder. Its major function is to "manufacture" a milky substance that aids in the transport of sperm. At a young age the prostate is the size of a hazelnut. In middle age the prostate begins to enlarge due to a complex interaction of hormone changes in a process known as BPH or benign prostatic hypertrophy. By the age of 80 nearly 80 % of males will have significant prostate gland enlargement.
WHAT ARE THE SYMPTOMS AND DIAGNOSIS OF PROSTATE DISEASE?
As the prostate enlarges with aging it compresses the urinary passageway. This urethral compression can explain many men's symptoms of hesitancy, slowing of the urine stream, voiding frequently, and dribbling. The Urologist will examine the prostate with a finger placed through the rectum to estimate the size of the gland and to check for cancer. Other examines such as a cystoscopy, prostate ultrasound, a kidney or bladder X Ray, or urine flow study will probably be recommended to study the degree of blockage from the prostate and to check for any bladder or kidney damage.
WHAT IS A TURP?
TURP is the abbreviation for Transurethral Prostatectomy. It is the golden standard treatment for prostate obstruction to which all newer modalities are compared. This operation is performed though the urethra, the natural passageway for urine, to remove the tissue blocking the urinary tract. It is accomplished with a highly refined surgical instrument called a resectoscope. This device, like a cystoscope, allows the operator to look into the bladder while he cuts the blocking tissue with an electrically heated "hot" wire loop. The bits of tissue are removed through a hollow sheath placed into the urethra. No incisions through the skin will be necessary.
WHAT CAN YOU EXPECT WHEN YOU AWAKEN FROM SURGERY?
A spinal anesthetic along with sedation is used during surgery so that you will sleep and feel no pain during the operation. You will awaken from your operation in the recovery room where you will notice a heaviness in your legs as the anesthesia wears off. A Foley catheter (a tube to drain urine) will be placed in the bladder during surgery to drain the urine and allow periodic irrigation to remove any blood clots . The catheter may cause a sense of urgency to urinate or burning. Medications will be available after your surgery to relieve any pain or bladder discomfort you may develop.
WHAT TO EXPECT THE DAYS AFTER SURGERY?
You should be eating and walking on the day of your surgery. The catheter is generally left in the bladder for one to three days depending on the amount of blood in the urine or presence of blood clots. Once the catheter is removed you will probably not urinate normally for several days to weeks. You will usually have a burning sensation with a sense of urgency to urinate. It is quite common to have poor urine control and a need to urinate frequently during the first week or so; and to have reddish colored urine with occasional clots for several days or weeks after your surgery.
WHAT ARE THE COMPLICATIONS OF A TURP?
- There is about a 2- 5 % chance that you will lose enough blood during the surgery that a blood transfusion may be necessary. If you are concerned about having a transfusion ask you Doctor about obtaining autologous blood (your own banked blood) before your operation.
- There is a small risk of major complications such as a heart attack, stroke, or even death. These risks are greater if you already have other major medical problems.
- Although you should not notice any significant changes in your sexual satisfaction about 60% of males may experience retrograde ejaculation or dry climax. This is where semen goes into the bladder after a climax rather than come out the penis.
- About 5 % of men may experience some erectile impotence after a TURP. This generally occurs in the more elderly individuals who may already be having some difficulties with their erections prior to the TURP.
- Occasionally scar tissue may form in the urethra known as a stricture . These generally can be handled in the office with a simple stretching of the urinary passage with local anesthesia. Occasionally the scar tissue can be quite dense and a reoperation may be necessary to correct the problem.
- Approximately 3% of individuals per year will require a reoperation of the prostate generally due to re growth of the prostate, prostate cancer, or incompletely resected prostate tissue due to large size of the gland.
Prostate cancer can develop after a TURP so that we recommend a reexam of the prostate on a yearly basis.
WHAT RESULTS SHOULD I EXPECT WITH THE SURGERY?
Currently the effectiveness all other procedures or medication are compared to a TURP. That is because a TURP is the Golden Standard for treatment of prostate obstructive symptoms. If you have moderate to severe symptoms prior to a TURP about 90 % of individuals enjoy an improved urinary stream. Your bladder should empty better and many of your symptoms of frequency, hesitancy, and dribbling should also improve. Depending of the severity of your pre operative symptoms, these changes can be quite dramatic. Some individuals may not notice quite as dramatic improvements and may be disappointed with the results. Poor results can often be traced to a improperly functioning bladder or development of scar tissue. Should things not be working right be sure and notify your Doctor so he can investigate the problem further and treat it as necessary.
WHAT ARE MY RESTRICTIONS AFTER SURGERY?
1. There are no strict restrictions in your activities after your surgery. You should avoid heavy or strenuous lifting; also be careful about sudden jerky actions; these might predispose you to bleeding.
2. Avoid sexual activity until follow-up with your doctor.
3. You can drive a car but try to avoid sudden motions. You should postpone long trips till your urine is clear for at least a week. The best plan is to wait 1 month before planning a major trip.
4. There are no diet or fluid restrictions. However , you are encouraged to drink plenty of fluid up to 8-10 glasses of water a day. Try to eat a balanced diet to help avoid constipation- straining can cause bleeding.
WHAT PROBLEMS CAN OCCUR WHEN I ARRIVE HOME ?
- You may note bloody urine or blood clots.
- Fever, chills, or possibly swelling or pain in the testicles...this is suggestive of infection.
- Difficulty voiding or inability to void ... this can occur when a blood clot or piece of tissue blocks the urine passageway.
