TURP

Transurethral

Telescopic Resection of the Prostate

TURP involves coring out your prostate gland to improve the flow of urine. TURP is the most commonly performed operation to improve urine flow and most men get good relief of their symptoms. A bladder catheter is used for a short time after the operation to wash out blood clots.

The most common after-effects are inability to emit semen during ejaculation and temporary bleeding, burning or urinary frequency.

What does this procedure involve?

The prostate gland sits around your urethra (waterpipe) as it leaves the bladder and, when it enlarges, it may block the flow of urine. TURP involves telescopic removal of the obstructing, central part of the prostate with diathermy (electric current), creating a wide channel to allow urine to flow more easily.

Usually, a temporary bladder catheter is inserted at the end of the operation.

What are the alternatives?

  • Drugs to improve urine flow: Tamsulosin, doxazosin, terazosin, finasteride, dutasteride
  • Observation: No treatment, but monitoring of any change in your symptoms; symptoms can improve over time without any treatment
  • Permanent catheterisation: Especially in patients who, for any reason, are not considered suitable for surgery , green-light laser prostatectomy or “open” surgery
  • Other surgical procedures: Including holmium laser enucleation of the prostate (HoLEP)

What happens on the day of the procedure?

Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent.

An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you.

We may provide you with a pair of TED stockings to wear, and we may give you a heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.

What are the details of the procedure?

We normally use a general anaesthetic (where you are asleep) or spinal anaesthetic (where you are unable to feel anything from your waist down). We usually give you an injection of antibiotics before the procedure, after you have been checked for any allergies.

We put a telescope into your bladder through the urethra (water pipe) and remove the central part of the prostate a piece at a time using a diathermy loop (pictured). The prostate is removed in small pieces, evacuated from the bladder by suction, and the chippings are sent for pathology analysis.

Once the prostate has been removed, we carefully coagulate (burn) any bleeding points in the cavity left by the surgery. We put a catheter into your bladder at the end of the procedure – we normally use bladder irrigation in and out of the catheter, to flush through any clots or bleeding.

On average, the procedure takes 45 to 60 minutes to complete. You should expect to be in hospital for one to three nights.

We normally remove your bladder catheter after one to four days. You may find it painful to pass urine at first and it may come more frequently than normal. Tablets or injections can help with this, and it usually improves within a few days.
Your urine may turn bloody for 24 to 48 hours after removal of your catheter and some patients cannot pass urine at this stage. If this happens, we put another catheter in, before removing it again 48 hours later.

Are there any after-effects?

The possible after-effects and your risk of getting them are shown below. Some are self-limiting or reversible, but others are not. We have not listed very rare after-effects (occurring in less than 1 in 250 patients) individually.

The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual.

 

Temporary mild burning, bleeding and frequent urination

Almost all patients

No semen is produced because it passes back into your bladder on ejaculation (retrograde ejaculation)

Between 2 in 3 & 3 in 4 patients

(65% to 75%)

Treatment may not relieve all your symptoms

Between 1 in 2 & 1 in 10 patients

Poor erections (in men with previously normal erections)

Between 1 in 10 & 1 in 50 patients

Bleeding requiring a blood transfusion or 

re-operation

Between 1 in 10 & 1 in 50 patients

Possible need to repeat the treatment at a later date due to re-growth of the prostate

Between 1 in 10 & 1 in 50 patients

Injury to the urethra causing delayed scar formation

Between 1 in 10 & 1 in 50 patients

Inability to pass urine after surgery requiring a catheter or intermittent self-catheterisation

Between 1 in 10 & 1 in 50 patients

Loss of urinary control, which may be temporary or permanent

Between 1 in 10 & 1 in 50 patients

Finding an unsuspected cancer in the removed tissue, which may need further treatment

Between 1 in 10 & 1 in 50 patients

Irrigating fluids getting into the bloodstream & causing confusion or heart problems

Between 1 in 50 & 1 in 250 patients

Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death)

Between 1 in 50 & 1 in 250 patients. Your anaesthetist can estimate your individual risk

 

What are the expected Complications of Adenoidectomy?

Your risk of getting an infection in hospital is approximately 8 in 100 (8%); this includes getting MRSA or a Clostridium difficile bowel infection. This figure is higher if you are in a “high-risk” group of patients such as patients who have had:

  • Long-term drainage tubes (e.g. catheters)
  • Bladder removal
  • Long hospital stays
  • Multiple hospital admissions

What can I expect when I get home?

  • You will be given advice about your recovery at home
  • You will be given a copy of your discharge summary
  • Any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy
  • You should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush your system through and reduce the risk of infection
  • You may return to work when you are comfortable enough and when your GP is satisfied with your progress
  • One patient in five (20%) gets some bleeding 10 to 14 days after getting home, due to scabs separating from the cavity of the If this happens, you should increase your drinking; if it does not settle, you should contact your GP who will prescribe antibiotics for you
  • If you have severe bleeding, pass blood clots or have sudden difficulty passing urine, you should contact your GP immediately; this may re-admission as an emergency

Some loss of control is common in the early days, so it is helpful to start pelvic floor exercises. It will be 14 to 21 days before the final biopsy results on the tissue removed are available. All biopsies are discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.

Most patients need two to three weeks at home before they feel ready for work. We recommend three to four weeks’ rest before you go back to work, especially if your job is physically demanding; you should avoid any heavy lifting during the recovery period.

The symptoms of an overactive bladder (frequent & urgent urination) can take up to three months to settle, whereas the flow of urine is usually improved immediately.

Before you go home, we will tell you how the procedure went and you should:

  • Make sure you understand what has been done
  • Ask the surgeon if everything went as planned
  • Let the staff know if you have any discomfort
  • Ask what you can (and cannot) do at home
  • Make sure you know what happens next
  • Ask when you can return to normal activities

We will give you advice about what to look out for when you get home. Your surgeon or nurse will also give you details of who to contact, and how to contact them, in the event of problems.

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