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Overview

 

About TURP

TURP is the most common operation for an enlarged prostate (benign prostatic hyperplasia or BPH). BPH, sometimes known as benign prostatic hypertrophy, benign prostatic obstruction, is an overgrowth of cells of the prostate that blocks the flow of urine, making it difficult to pass urine.

  


Benign Prostate Hyperplasia

Benign prostate hyperplasia (BPH) is one of the most common urological conditions among elderly male, with 60% incidence for those above 60 years old. It is a non-cancerous enlargement of the prostate gland that may restrict the flow of urine from the bladder.

Symptoms of BPH include : -
  • Difficulty in starting urination (hesitancy)
  • A weak urinary stream
  • Interruption of the stream ('stopping' and 'starting' effect)
  • Sensation of incomplete bladder emptying
  • Urgency (difficulty in postponing urination)
  • Frequent urination
  • Waking up frequently at night to urinate (nocturia)


BPH is usually diagnosed upon a review of the patient's medical history as well as a physical and digital rectal examination.


Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

You will need to stay in hospital for about four days. The operation is usually done under general anaesthesia. This means you will be asleep during the operation. Alternatively, you may prefer to have the surgery under spinal or epidural anaesthesia. This completely blocks feeling from the waist down and you will stay awake during the operation. You may be offered a sedative with a spinal anaesthetic to help you relax during the operation. Your surgeon will advise which type of anaesthesia is most suitable for you.

If you're having general anaesthesia, you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours beforehand. However, some anaesthetists allow occasional sips of water until two hours before a general anaesthetic.

At the hospital your nurse will explain how you will be cared for during your stay. Your nurse may check your heart rate, blood pressure and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as, or instead of, stockings.

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About the operation

The operation itself takes up to an hour and a half. A TURP is usually performed under a general anaesthetic so that the man is asleep and feels no pain throughout the procedure. Typically, no food and drink is allowed for about six hours before a general anaesthetic. However, some anaesthetists allow a few sips of water until two hours beforehand. A TURP usually involves a hospital stay of around four days. The operation itself takes about an hour.

Once the anaesthetic has taken effect, the surgeon inserts a thin, tube-like telescope (a resectoscope) into the urethra. The resectoscope includes a camera and specially adapted surgical instruments. This allows the surgeon to see the prostate clearly. A wire loop attachment that carries an electric current is used to "chip away" at the prostate. The same instrument, with a different type of electric current, is used to stem any bleeding. During the operation, the bladder is flushed with a sterile solution to remove the chippings of prostate tissue. A catheter (a thin flexible tube) is then inserted through the urethra into the bladder.


What to expect afterwards ?
  • You will need to rest until the effects of the anaesthetic have passed. You may not be able to feel or move your legs for several hours after a spinal or epidural anaesthetic.
  • You may need pain relief to help with any discomfort as the anaesthetic wears off.
  • You will have a catheter to drain urine from your bladder into a bag. The catheter is also used to wash out your bladder with a sterile solution. This helps to flush out any blood clots in your bladder.
  • Tell your surgeon or nurse if your bladder starts feeling full - sometimes a small blood clot can block the catheter.
  • The catheter will be removed when your urine begins to run clear. This is usually within two to three days.
  • You may have a drip in your arm to prevent dehydration - this will be removed once you're drinking enough fluid.
  • You will be encouraged to get out of bed and move around as this helps prevent chest infections and blood clots in your legs.
  • You will usually be able to go home after about four days.
  • You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.


Recovering from TURP

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. General anaesthesia can temporarily affect your coordination and reasoning skills, so you shouldn't drink alcohol, operate machinery or sign legal documents for 48 hours afterwards.

You should drink enough fluid to flush out your bladder and help you to recover. You should drink enough so that your urine appears pale yellow.

It can take up to six weeks to recover fully from TURP. After two weeks you can resume your normal activities, including sex. You shouldn't do any strenuous activity for about six weeks after the operation. Follow your surgeon's advice about driving. You shouldn't drive until you're confident that you could perform an emergency stop without discomfort. This is usually about six weeks after the operation.

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Q. What are the risks ?

TURP is commonly performed and generally safe. However, in order to make an informed decision and give your consent to the procedure, you need to be aware of the possible side-effects and the risk of complications.

Side-effects of TURP

These are the unwanted, but mostly mild and temporary effects of a successful treatment. For example, feeling sick as a result of the general anaesthetic and some discomfort from the catheter.

Some specific side-effects can be expected as a result of this operation, including the following.
  • Blood in the urine or semen : - this will clear up after about two weeks. An urgent need to pass urine. You may also feel a burning sensation when you do pass urine - this will clear up after a few weeks.
  • Incontinence (urine leakage) : - talk to your doctor if this happens, but it nearly always clears up.
  • Impotence : - this isn't usually a problem and some men find their erections improve.
  • Retrograde ejaculation : - where semen passes into your bladder during orgasm instead of out of the penis. Retrograde ejaculation isn't usually a problem, but it may reduce fertility.


If you develop a fever, have pain when passing urine or if your urine is smelly, you should see your GP as you may have an infection.


Complications of TURP

This is when problems occur during or after the operation. Most men aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of this operation include those listed below.
  • Infection : - You will be given antibiotics before the operation if you're at high risk.
  • TURP syndrome : - This is where the fluid used to flush your bladder during the operation is absorbed into your body. This can cause low blood pressure (hypotension) and you may feel sick or vomit.
  • Repeating the operation : - This may be required if your prostate grows back, or if too little was removed during the first operation.


The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.


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