A transurethral resection of prostate or TURP procedure involves the surgical removal of the central portion of the prostate (the “transition zone”). It is this portion of the prostate that enlarges with age and causes progressive blockage to the flow of urine out of the bladder. Before this operation is performed, almost every patient has been treated with medications aimed to reduce this blockage. In addition, many patients will have had a special test called Urodynamic Studies, to prove that it is in fact the enlarged prostate that is responsible for the symptoms that you are experiencing.
These symptoms include:
- straining (need to push to begin urination)
- hesitancy (delayed onset of urination following the urge to urinate)
- slow or diminished force of stream
- interrupted flow (urine stream that starts and stops)
- a sensation of incomplete emptying of your bladder
Other symptoms that may be associated are what we call irritative symptoms and include: frequency of urination, urgency to urinate and nocturia (getting up at night to urinate).
A transurethral resection of prostate takes from 30-90 minutes. You will be placed in lithotomy position (lying down on your back with your legs gently elevated in holsters called stirrups). The procedure involves the passage of a special instrument (a resectoscope) into the inner portion of the prostate. The portion of the prostate is literally shaved using an electrified loop to widen the passage through which the urine passes. Think of it like coring an apple. As the shaving process proceeds, the small pieces of shaved prostate are deposited in the bladder. Bleeding vessels in the prostate are simultaneously cauterized as the shaving process proceeds.
At the end of the procedure any residual bleeding vessels are cauterized and the small pieces of prostate that have been deposited within the bladder are flushed out. A catheter is left in place which will continually flush the bladder.
A transurethral resection of prostate procedure may also be performed using a laser. One major disadvantage of the laser procedure is that tissue is not obtained for analysis, as it is vaporized. If a cancer is present, it will be missed should the procedure be performed with a laser. If desired, Dr Sved’s patients have access to the latest Green-light KTP laser at RPA Hospital.
Please refer to the detailed information provided by the rooms. You may also be able to access this information on this website. There is no particular preparation for this procedure. It is necessary, as with any procedure or operation requiring anaesthesia, that you have not eaten for at least 8 hours prior to the scheduled time.
You will be asked to stop and blood-thinning medications 5-7 days before the procedure. These medications include Aspirin, Warfarin and Plavix.
Transurethral Resection of Prostate – Post Procedure
It is normal for you to feel a strong sense of urgency to urinate. This is from the procedure and from the presence of the catheter. In most patients, this dissipates within a couple of hours. Some patients require medications to help relax the bladder while the catheter is in. Your catheter may be attached to a large bag that runs fluid into your bladder (irrigation) to keep it washed out. Through a separate channel in the catheter, the fluid runs out into a drainage bag. This continuous bladder irrigation (CBI) is done to prevent blood clots from obstructing the catheter. The rate of the irrigation will be adjusted by the doctor or the nurses to a rate that keeps your urine on the clear side.
The catheter will be removed once the urine is clear. This may be the day after surgery or the next 2-3 days. Once the catheter is removed, and you are passing urine, you will be discharged from hospital.
Typically, you can return to work within a few days to a week. If your occupation requires heavy lifting or straining, please let us know so that we may keep you out of work for a slightly longer period.
Expectations of Outcome
Most patients are very satisfied after the procedure. The improvements that are typically noted immediately after the operation are:
- stronger force of stream
- decreased standing around waiting for the urination to commence
- decreased need to push
- loss of interruption of flow (ie. where the flow used to start and stop and start, etc.)
- loss of the sensation that you are “not really emptying your bladder”
In some patients, it may be difficult to control the urine for a couple of weeks. In addition, you may have a burning sensation when passing urine. This symptom usually resolves within one month after the procedure. You may notice that you are still voiding frequently and with some urgency (sensation that forces you to get to the bathroom quickly). These symptoms can take a long time to disappear. In patients that were significantly obstructed for a prolonged period, these symptoms may never fully resolve. Nocturia (getting up at night to urinate) is typically the last symptom to resolve. In many instances, it may become less frequent, but never fully disappear. The reason is that nocturia can be due to several other physiological issues and also because the night-time ritual becomes somewhat habitual.
Retrograde ejaculation is when the semen (during ejaculation) goes backward into the bladder instead of forward and out of the penis. This is expected to some degree in almost all patients. It may be that your semen volume is less, or absent altogether. You will still have the sensation of orgasm, but you may not see the semen. In this regard, you may be considered sterile.
Possible Complications of the Procedure
The vast majority of patients will not experience any problem after a TURP. However, any procedure, regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. These may include, but are not limited to:
As we scrape the prostate tissue, small blood vessels bleed. Throughout the entire procedure, we cauterize (burn) the vessels shut. At the end of the procedure, we carefully inspect the area to ensure that there is no significant bleeding. If bleeding is excessive, the rate of irrigation through the catheter is increased, and the catheter may be placed on traction to compress bleeding vessels. Very rarely, we have to return to the operating room to put the scope back inside the bladder and re-cauterize. If bleeding is prolonged during or after the operation, we would check your blood count. It is rare to need a blood transfusion following a TURP (less than 1% chance).
- Urinary Tract Infection or Urosepsis (Bloodstream Infection)
Before this procedure can take place, we must confirm that you do not have an active urinary tract infection. If a urinary tract infection is not present, it is most unlikely that you will suffer sepsis after this procedure. In the rare event that you do, you will be given intravenous and oral antibiotics. This scenario is more common in diabetics, patients on long-term steroids, or in patients with disorders of the immune system.
- Urethral Stricture / Bladder Neck Contracture
A stricture is scar tissue that can form anywhere in the urethra following instrumentation. It typically occurs weeks to months (or even longer) after the procedure. Scar tissue can also form at the exit (neck) of the bladder, and this is termed a bladder neck stenosis. For either condition, it may be necessary to schedule another scope procedure to open the scar. These procedures can be done with a small blade, electric knife, or with a laser; and they are quick and almost always an outpatient procedure. A scar at the tip of the urethra can sometimes be dilated (spread open) in the office. In rare instances, a stricture or contracture can recur in the future.
- Urinary Incontinence
Very rarely, during a TURP, the sphincter muscle that controls continence may be weakened. This may lead to urinary leakage. This leakage may resolve in time but, extremely rarely may be permanent. Sometimes, if the bladder is overactive before the procedure, leakage may occur after the prostatic obstruction has been relieved. This “urge incontinence” usually resolves with the use of medications aimed to relax the bladder.
- TUR Syndrome
If there is excessive absorption of irrigating fluid during the procedure, the blood can become somewhat diluted. The changes in the blood could affect the blood pressure, the heart, and in severe instances, the brain. With the newer fluids, more advanced equipment, and more efficient ways to treat even the suspicion of “too much absorbed fluid”, TUR syndrome is extremely rare.
- Erectile Dysfunction
According to the literature, anywhere from 5-25% of patients complain of some degree of erectile dysfunction (ED or impotence) after a TURP. For the majority of these patients, the patient notes a change but does not complain of complete impotence. Most studies report ED numbers on the lower end of the spectrum. This problem has always been quite puzzling to urologists in that a sound “cause and effect relationship” has not been established. The most plausible explanation may be the transmission of the energy source through the entire thickness of the prostate and subsequently to the nerves controlling erections. Psychological and other pre-existing factors may place a role as well.
Please follow the instructions given to you by the hospital regarding when you should make an appointment to see Dr Sved. You may be seen in his offices at RPA, Bankstown or Strathfield Private Hospital.Do not hesitate to call our office at any time if you have any concerns.