The prostate is a small gland, normally about the size of a walnut, located under the bladder and surrounding the urethra (the urinary canal).
With age, the prostate often widens and compresses the urethra, making it more difficult for the bladder to empty. It has been determined that your difficulty in urinating is due to an obstruction caused by the prostate (benign prostatic hyperplasia or BPH). After discussing with you and considering all aspects of your case, you and your urologist have decided that prostate surgery is the best option for you.
Most affected men can be effectively treated by operating inside the prostate with a special instrument introduced through the penis: transurethral resection of the prostate or TURP. This eliminates the obstruction, allowing the urine to flow more freely and the bladder to empty more completely.
Your surgery will be at the hospital. We will contact you to advise you of the time, date and place of the procedure and any necessary preoperative examination. An anesthesiologist may discuss with you before surgery the best way to maintain your comfort during the procedure.
The risk of bleeding increases in patients taking anticoagulants, aspirin or certain arthritis medications. These medications should usually be discontinued before surgery. Please discuss this issue with your doctor.
Most patients are admitted to the hospital on the morning of the surgery. You will have discussed with your anesthesiologist various options to avoid pain during surgery, usually spinal anesthesia (“freezing” down the waist with an injection in the back) or general anesthesia ( to fall asleep).
This surgery is performed using an instrument called resectoscope that is introduced through the urethra. No skin incision is necessary. The inside of the prostate, which causes the obstruction, is removed in small pieces, which are then removed from the bladder. Bleeding is controlled by cauterizing with an electric current. The procedure usually lasts no longer than 90 minutes.
At the end of the surgery, a urinary catheter (drain tube) is inserted through the penis to the bladder. An aqueous solution is often used to clean the bladder and wash any blood that maybe there.
All removed tissues are carefully examined to determine their exact nature. TURP does not affect the risk of developing prostate cancer.
When the surgery is over, you will stay one or two hours in the recovery room or until you are no longer under the effects of anesthesia. We will then take you back to your room to the care unit, where you can drink and eat.
The urinary catheter is usually left in place for one or two days until the urine is almost clear. During this time, it is possible that one continues to wash your bladder with an aqueous solution. The presence of the urinary catheter in the bladder may be uncomfortable, usually mildly, and occasional bladder cramps may occur. Medications can relieve you. When you urinate satisfactorily, you can leave the hospital, usually one to three days after your operation. Some men may return home with their urinary catheters, which will be removed after a few days or as directed by the urologist.
After the urinary catheter has been removed, you may notice that your urination control is imperfect: the urge to urinate may come very quickly and urine dribbles. This usually disappears after a few weeks, when the inflammation disappears and the muscles are stronger.
When you come home, you should avoid lifting heavy objects (more than 10 kilos or 20 lbs.), Strenuous physical activity and traveling for four to six weeks. There may be some blood in your urine or even small clots until about three weeks after surgery. Continue drinking plenty of fluids (approximately 8 ounces every two hours while awake) to allow for regular emptying of the bladder unless advised by your doctor. Six to eight weeks after your TURP, you should see a significant improvement in urination and urine flow.
Risks and complications
There is a low risk of infection requiring treatment with antibiotics and, rarely, bleeding that requires a blood transfusion.
Frequently, sperm volume decreases due to sperm returning to the bladder at the time of orgasm; it is retrograde ejaculation. This should not affect your pleasure or that of your partner. In almost all operated men, the ability to have an erection does not change after a TURP.
Some men may still not be able to control their urination properly after TURP. This may require treatment with medications or other surgery. Abnormal scarring or new growth of the prostate may occasionally require further examination and treatment.