A B C D E F G H I J K L M N O P R S T U V W

PROSTATECTOMY : TURP OPERATION

Why is Prostatectomy performed ?

A prostate operation is performed to remove most or all of the prostate gland which has enlarged and has caused obstruction to the bladder. The way out of the bladder will become wider and the urine will therefore pass more easily. After a prostate operation, the urinary flow will be much stronger and the need to pass urine will be less frequent.

Preparations needed for a Prostatectomy

Although the operation usually takes only 45 minutes, pre-operative checks are necessary to ensure safety. Sometimes the blood tests, urine tests, x-rays and electrical heart tracing (ECG) will be done a few days before hospital admission, to check that general health is satisfactory. Alternatively, these checks will be made on the day before surgery. The total hospital stay will be on average 4 to 5 days, but in very elderly patients this may be extended.

What Happens during a Prostatectomy

Almost all prostate operations are performed transurethrally. This means that a telescopic instrument is inserted into the bladder via the urethra throughout the length of the penis. The surgeon can see the enlarged prostate and uses an electric current (diathermy) to remove the prostate in small pieces. The pieces of prostate are removed through the same instrument at the end of the operation. A general anaesthetic is usually required, although a regional (spinal or epidural anaesthetic may be possible: this deadens the area being operated upon). At the end of the operation, a catheter tube is placed in the bladder and emerges from the end of the penis. This tube drains blood and urine from the bladder and remains for 48 72 hours following the operation. It does not cause pain but can be uncomfortable when moving. Usually the catheter tube is removed on the second or third day after the operation. The patient remains in hospital for 12-24 hours, to ensure that all is well before going home. At this stage the urine may still be blood-stained, and the desire to pass urine may be surprisingly urgent. Both these features are common, and should subside over the next 2 weeks.

Possible Complications during a Prostatectomy

Transurethral prostatectomy is a very frequently performed operation, with a low complication rate. A little bleeding and a stronger than usual desire to pass urine can occur quite commonly in the first month following operation. Some discomfort on passing urine may also persist for 2 3 weeks. The full benefits of the operation may therefore take a month or so to be evident. Excessive bleeding sometimes occurs immediately after the operation and can be treated by blood transfusion. A second operation to stop the bleeding is seldom required. The bladder may need to be flushed through with fluid to wash out blood clot. A failure to pass urine properly when the catheter is removed may be due to a blood clot or to a remaining piece of prostate. The catheter will need to be replaced and sometimes further operation is necessary. Inability to control the flow of urine is very rare following a prostate operation. It is difficult but not impossible to treat.

After a Prostatectomy

A little discomfort and bleeding on passing water is common for the first few weeks. More severe bleeding may occur in the second to fourth week after operation. This is bright red persistent bleeding and is called secondary haemorrhage. If this occurs, contact the doctor. Re-admission to hospital for observation and possibly transfusion may be needed. A persistent strong desire to pass urine may also occur, but usually gets better with time. It may take 3 4 months. You will usually be given an appointment to see the urologist a couple of months following the operation. By this time, most of the discomfort should have settled. You should be passing urine much more easily, but the purpose of the check is to ensure that all is well. Following the operation it is wise to take one month off work or from strenuous activity. Bicycle riding, sport and sexual activity should be avoided in the first 6 post-operative weeks. When sexual activity is resumed, you will probably notice that the semen is no longer emitted from the end of the penis. The sensation of orgasm is present but altered, as the semen is ejected backwards into the bladder. It will therefore not be possible to father children, although the performance of the sexual act should not be altered. The ability to get an erection will very occasionally be affected by a prostate operation. At present, urologists are unable to predict which patients will have this problem. Finally, the operation may have to be repeated : five years after an operation, about 1 in 10 men require repeat surgery.

If a Prostatectomy is not performed

In about a quarter of patients, the symptoms remain unchanged. Often the symptoms gradually or suddenly worsen. The bladder may hardly empty at all or may cause back pressure on the kidneys, causing kidney failure. This may produce symptoms of general ill health and sickness, but can get to quite an advanced stage without producing any symptoms at all. If the bladder cannot empty properly, the urine may become infected, causing pain and fever. It may be that you are unable to pass any urine at all. This is usually painful and emergency hospital admission is required to drain the urine with a tube called a urethral catheter. If this happens, prostate operation will almost certainly be needed. Occasionally the bladder distends more slowly and without pain. Eventually the urine begins to leak. This is called chronic urinary retention and also requires treatment by bladder catheter and often an operation.