Transurethral Resection Of The Prostate (TURP)

The prostate

The prostate is a chestnut shaped gland that sits below the bladder. It surrounds the beginning of the urethra (the tube that empties the bladder) at the bottom of the bladder (bladder neck).

The size of the prostate can vary depending on age, although on average it is around 15cc and 3cm in diameter up until 40-50 years when it can enlarge.

The prostate is a part of the male reproductive system. It releases a milky fluid ejaculate that supports sperm.

Benign prostatic enlargement

This is a non-malignant enlargement of the prostate which is associated with age. It is usually not cancer and occurs commonly in men over 40-50 years of age. The exact cause is unknown but thought to due to the length of time the prostate is exposed to testosterone as a man ages.

It can cause bladder outflow obstruction producing lower urinary tract symptoms (LUTS) such as a poor flow, terminal dribbling and difficulty emptying the bladder. Usually men seek help because of the bothersome urinary symptoms and lack of quality of life rather than the size of the prostate itself.

Transurethral Resection of the Prostate (TURP)

This operation involves passing a cystoscope through penis up to the prostate. An electric loop is used to shave the inside of the prostate to widen the urethra running through it. The loop allows electrical cautery to control any bleeding.

A catheter is inserted into the bladder at the end of the procedure for continuous irrigation. The 3-way catheter has a port for the balloon, and inlet and outlet ports for fluid irrigation. This system simultaneously infuses fluid and drains urine at the same time to flush any blood clots from the bladder immediately after the operation.

The irrigation solution used is normal saline (salty water). The irrigation may be run quickly at first but can be adjusted depending on the amount of blood. This will continue until you have the catheter removed.

Before hospital

Take the admission book to hospital. Usually a pre-admission clinic appointment is organised prior to the procedure.
The hospital will call you the night before to tell you when to fast and when to come in to hospital
Practice pelvic floor exercises and maintain regular bowel activity
Bring in all your regular medications and check with your surgeon if any blood thinners need to be stopped temporarily
Bring in pyjama pants with an open fly and button at the top to accommodate the catheter
The hospital stay is usually for 2 nights. Please ask friends or family to help with travel to and from the hospital.

In hospital

Stockings will be given to you to wear to prevent blood clots developing in the legs veins (deep vein thrombosis). If a spinal anaesthetic is used, you will need to stay in bed for the first night as your legs will take some hours before normal power and sensation returns.

Once returned to the ward tolerating fluid without nausea or vomiting, the nurses will organise your meals. Occasionally men feel they need to open their bowels and it is often only wind. A bed pan may be required for the first night.

There may be discomfort at the tip of your penis or you may experience bladder spasms. These are both due to the catheter and irrigation. If pain is experienced please alert the nurse so she can check that the catheter is draining properly and organise appropriate pain relief. The bladder spasms generally subside when the catheter is removed.

The next day the intravenous cannula is usually removed. You can walk to the shower and around the ward with a pole that holds the fluids irrigating the catheter. Sitting out of bed, deep breathing and coughing will help your lung function.

Removal of the catheter

The catheter is usually removed by your nurse after the second day once reviewed by your surgeon. You may experience momentary discomfort but most men are relieved to have it removed.

A “trial of void” is given where you pass around three times prior to discharge to ensure you are comfortably emptying your bladder. Pass urine into a bottle and notify the nurse who will perform an ultrasound bladder scan to measure any residual urine. You may be asked to “double void” if there is still a lot of urine remaining.

At home

Avoid heavy lifting for around 6 weeks until your follow-up appointment. Avoid constipation, straining to open bowels or heavy physical activity as this will increase the risk of bleeding. Light exercise such as walking is important.

Return to your usual diet and drink 8-10 glasses of water to keep the urine clear. Limit bladder irritants such as caffeine, fizzy drinks and alcohol which may worsen urgency and frequency.

Continue your usual medications. Notify your surgeon if you are on blood thinners for advice on when to restart them. As a general rule, it is reasonable to restart blood thinners if the urine is visibly clear.

Follow-up

A review appointment around 6 weeks after the TURP is usually made at the time of booking the procedure. After the TURP, prostate medications such as tamsulosin or duodart are not required. Our specialist nurses will call 1-2 weeks later to answer any questions and ensure you are recovering appropriately.

Normal symptoms after the TURP

The following symptoms are worse in the first few weeks after the operation but generally subside within 3 months. You may experience

Burning, frequency and urgency. This is related to irritation from the raw prostate. Even though there are no cuts on your body, there is still a cut on the inside of your prostate that is the reason for these symptoms. It is normal and quite variable between men. This can improve with drinking enough fluid to keep your urine clear. Sometimes taking Ural can improve the burning as well.
Blood in the urine is normal and usually settles with time. Avoid heaving or straining when opening your bowels to reduce the risk of bleeding. It is very common to experience slightly worse bleeding 7-10 days after the operation and may be due to a “scab” that falls off the raw surface of the prostate.
Dry ejaculations are expected after the procedure as fluid deposited into the prostate on orgasm usually refluxes into the bladder now that the prostatic urethra has been opened up.

Problems

With any surgery, problems may occur.

Excessive bleeding that is causing large clots or very “gluggy” urine may block the bladder. Attend the emergency department if you are worried as another irrigating catheter may need to be re-inserted to wash out the bladder.
Signs of an infection such as high temperatures, feeling chills or unstoppable shivering may require antibiotics. This may be accompanied by offensive smelling urine.
Please attend Lake Macquarie Private Hospital Emergency if insured or your nearest emergency department if these problems occurs. Our specialist urology nurses are usually available for phone advice during working hours.