What does the procedure involve?
This operation involves the telescopic removal or incision of the obstructing, central part of the prostate with heat diathermy and temporary insertion of a catheter for bladder irrigation
What are the alternatives to this procedure?
Drugs, use of a catheter/stent, observation or open operation, laser enucleation of the prostate (HoLEP), laser ablation (e.g. GreenLight)
What should I expect before the procedure?
You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will be asked not to eat or drink for 6 hours before your operation.
What happens during the procedure?
Either a full general anaesthetic (where you will be asleep throughout the procedure) or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down) will be used. All methods minimise pain; your anaesthetist will explain the pros and cons of each type of anaesthetic to you. A telescope is passed into the bladder and the central part of the prostate removed piecemeal using heat diathermy. The prostate fragments are evacuated using suction and sent for pathological analysis. A catheter is usually inserted after the procedure. The procedure takes 45-60 minutes. You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
What happens immediately after the procedure?
There is always some bleeding from the prostate area after the operation. The urine is usually clear of blood after 48 hours, although some patients lose more blood for longer. If the loss is moderate, you may require a blood transfusion to prevent you from becoming anaemic. You will be able to eat and drink the morning after the operation although this may be allowed earlier after a spinal anaesthetic.
The catheter is generally removed after 2-3 days, following which urine can be passed in the normal way. At first, it may be painful to pass your urine and it may come more frequently than normal. Any initial discomfort can be relieved by tablets or injections and the frequency usually improves within a few days. It is not unusual for your urine to turn bloody again for the first 24-48 hours after catheter removal. A few patients are unable to pass urine at all after the operation. If this should happen, we normally pass a catheter again to allow the bladder to regain its function before trying again without the catheter. The average hospital stay is 2 days for a routine admission.
Are there any side-effects?
Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.
The operation leaves a raw area in the urine passage, which then rapidly heals over. Occasionally you can get quite heavy bleeding from the raw area either during or shortly after the operation. This is usually corrected by flushing the bladder through the catheter. The chance of this happening is about 3 in a 100 (3%). Very occasionally we have to give a further anaesthetic to flush the bladder and stop the bleeding with the telescope. Some men do have some bleeding in the week after the operation at home; this can be set off by straining to open your bowels for example. Usually this settles by drinking plenty but you may have to return to the ward for a simple bladder flush. Please take it easy during the first 2 weeks after surgery to minimise the risk of bleeding.
Having an anaesthetic and an operation may make other illnesses such as angina or bronchitis worse. If you suffer such health problems the anesthetist, surgeon and ward staff will take special care during your hospital stay. The chance (risk) of having something go wrong with your general health whilst you are in hospital is about 2 in a 100 (2%), but this depends upon your age and other health problems you may suffer from.
Enlargement of the prostate is caused by benign changes in the gland. We do however get our pathologist (a doctor who examines tissue under the microscope) to look carefully at the pieces of the prostate removed during the operation. This careful examination sometimes reveals abnormal cells, which are a form of prostate tumour or cancer. However most of these tumours are tiny and dormant and won’t cause any further trouble. We will usually continue to keep an eye on the prostate if such a tumour is found for a number of years just to be sure. We find such tumours in about 1 out of every 10 (10%) men who have a prostate operation. You will be told about the results of the tissue examination by letter or at your follow up appointment.
The main side effect of the operation is re-routing of the ejaculation of semen that occurs when you have sexual intercourse. Instead of coming out of the tip of the penis it goes into the bladder. This means that your ejaculation will be “dry” but you may find your urine is cloudy with the semen the next time you go to the toilet. This happens to about 75% men who have a TURP, but to only 50% men who have a BNI.
Some men (10-15%) find that their sex life isn’t as good after the operation either because the feelings are less strong or their erection is less stiff. Other men find their sex life is improved since they don’t have to worry about their urinary symptoms.
A few men find that the urine flow slows down again a few months after the operation. This is usually due to a narrowing in the urine tube that can be simply fixed by gently stretching the tube under anaesthetic.
Is the operation always successful?
When men are asked about their prostate operation about 80% say they are extremely happy with the results. If we put this the other way around it means that about 2 out of every 10 (20%) men who have prostate operations feel that they haven’t gained much benefit. The operation is very unlikely to make your symptoms worse however.
Symptoms such as having to rush to the toilet (urgency) are caused by over activity of the bladder muscle, and it is often this symptom that doesn’t get better after the operation and which makes men unhappy with the result. It can however be controlled to some extent by tablets. Most men find that their symptoms are dramatically better immediately after the operation; other men feel that they gradually improve over 2 – 3 months.
Since we don’t remove all the prostate gland it will continue to grow to some extent. We find that about 1 in 10 (10%) of men will need a second operation in their lifetime, usually 10 – 15 years after the first one.
Incontinence is rare after a TURP but it does occur in less than 2%. It may be temporary or permanent and further treatment may be required.
What should I expect when I get home?
When you leave hospital, you will be given a “draft” discharge summary of your admission. This holds important information about your inpatient stay and your operation. If, in the first few weeks after your discharge, you need to call your GP for any reason or to attend another hospital, please take this summary with you to allow the doctors to see details of your treatment. This is particularly important if you need to consult another doctor within a few days of your discharge. Most patients feel tired and below par for a week or two because this is major surgery. Over this period, any frequency usually settles gradually.
What else should I look out for?
If you experience increasing frequency, burning or difficulty on passing urine or worrying bleeding, contact your GP.
Are there any other important points?
Removal of your prostate should not adversely affect your sex life provided you are getting normal erections before the surgery. Sexual activity can be resumed as soon as you are comfortable, usually after 3-4 weeks. It is often helpful to start pelvic floor exercises as soon as possible after the operation since this can improve your control when you get home. The symptoms of an overactive bladder may take 3 months to resolve whereas the flow is improved immediately. If you need any specific information on these exercises, please contact the ward staff or the Specialist Nurses.
Most patients require a recovery period of 2-3 weeks at home before they feel ready for work. We recommend 3-4 weeks’ rest before resuming any job, especially if it is physically strenuous and you should avoid any heavy lifting during this time. You should not drive until you feel fully recovered; two weeks is the minimum period that most patients require before resuming driving.
