TURP (Transurethral Resection of the Prostate)
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Prostate surgery is available for men with prostatic enlargement causing obstruction of the flow of urine. This enlargement is usually benign. If treatments such as lifestyle modifications and medications do not work, surgery is a good option. Men with major problems from prostatic enlargement, such as bleeding, infection, or inability to urinate, may benefit from having surgery directly, without trying other measures first.
About the Procedure
The most commonly used and gold standard operation for enlarged prostate is called a TURP (transurethral resection of the prostate). The procedure is performed through the natural channel (urethra) without an incision. The inner, obstructing portion of the prostate is removed in small pieces to open the channel.
The operation takes about 1 to 1½ hours and can be done under general or regional anesthesia, such as a spinal. Spinal is usually the preferred anesthesia, because the risks are lower than with other types.
Preparation
It is important to be off of Coumadin, aspirin, and any other blood thinners for 7 to 10 days before the procedure.
Risks
The most common complication of prostate surgery is bleeding. Bleeding is controlled with electrocautery during surgery and bladder irrigation, which is used after the surgery while you are in the hospital. Small amounts of bleeding after the surgery are expected, but larger amounts may rarely require blood transfusion or catheter replacement (if a clot blocks urine flow).
Other problems that may be seen after the surgery include infection and healing with scar tissue at the bladder neck or in the urethra (called a stricture). Strictures usually require reopening with a minor surgical procedure or dilation. This is not common.
Incontinence is a rare complication, except in patients who have had previous nerve damage to the bladder or a weakened urinary sphincter muscle. Occasionally, a weak bladder makes it difficult to empty even after surgery has removed the obstruction. This can usually be predicted with preoperative testing.
Patients with longstanding obstruction or other problems that have caused their bladder to weaken may not have an improvement in their symptoms after surgery, even though the obstruction has been relieved. Preoperative testing can sometimes predict this.
Sexual side effects include retrograde or dry ejaculation. After prostate surgery, men may not ejaculate the same way they did before. This is usually because the semen now passes backwards into the bladder instead of out. This is not harmful, and is only a problem if a man is trying to conceive a child.
Occasionally, patients report difficulty with erections after this surgery. Erectile problems are very common in men who need this surgery, and it is not clear whether these are related. Most men with good erections before surgery maintain them.
After Surgery
After you leave the hospital, it is important to avoid strenuous activities because these can increase the risk of bleeding. It is normal to see small amounts of blood in the urine for several weeks after surgery, but the stream should remain improved. Every time a patient voids after surgery, he can tell if the bleeding is active or not; if there is a substantial amount of blood in the urine, he should refrain from any activities that increase the heart rate or blood pressure or require straining until the bleeding clears. If you have bleeding that forms blood clots, a catheter may need to be reinserted temporarily.
Urinary frequency and minor urge leakage can also occur, and these usually resolve with time.
Sexual activity can usually be resumed 4 weeks after surgery.
Driving is safe after 2 weeks, as long as there is no visible blood in the urine.
The specimens removed during surgery will be analyzed by the pathologist, and this report will be discussed with you at your follow-up visit. Occasionally, an unsuspected prostate cancer is found. This cancer may or may not need further treatments.