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TRANSURETHRAL RESECTION OF THE PROSTATE (TURP)

 

Prostate Problems and Related Urinary Symptoms

To better understand why you need TURP, it helps to know about your prostate.  The prostate is a gland about the size of a walnut.  It makes some of your semen (the fluid that carries sperm).  Many men have problems with the prostate at some time in their lives. The prostate gland is part of the male reproductive system. It’s located just below the bladder. The prostate surrounds the urethra (the tube that carries urine out of the body). When problems occur in the prostate, the bladder and urethra are often affected as well. Urinary symptoms can result. The most common prostate problems are described below.

Cutaway view of prostate BPH

BPH (benign prostatic hyperplasia) develops when changing hormone levels cause the prostate to grow larger. This often begins around age 50. Excess tissue can block the urethra, making it harder for urine to flow. The enlarged prostate can also press on the bladder, so you may need to urinate more often. Other symptoms include straining during urination, a weak urine stream, and feeling that the bladder isn’t emptying all the way. Note that BPH is not cancer and does not cause cancer.

How BPH Affects the Bladder

Pushing to urinate through a narrowed urethra can cause the bladder walls to thicken or stretch out of shape. A stretched bladder may have problems emptying all the way. Infections or bladder stones can occur. Also, the kidneys can’t drain properly into a bladder that doesn’t empty completely. This can lead to kidney failure. Pressure from urine buildup can also cause leaking of urine (called overflow incontinence).

Other Prostate Problems

  • Prostatitis is an infection or inflammation that causes the prostate to become painful and swollen. This narrows the urethra and can block the bladder neck. Prostatitis can cause a burning sensation during urination. You may also feel pressure or pain in the genital area. In some cases, prostatitis can cause fever and chills, and can make you very sick.

  • Cancer occurs when abnormal cells form a tumor (a lump of cells that grow uncontrolled). Some tumors can be felt during a physical exam, others can’t. Prostate cancer often causes no symptoms at all, especially in its early stages. Prostate symptoms are more likely to be caused by a problem that is NOT cancer.

 

 

 

Transurethral Resection of the Prostate (TURP)

TURP is a type of surgery used to treat a benign enlargement of the prostate, also known as BPH (benign prostatic hyperplasia). This surgical treatment removes prostate tissue to relieve pressure on the urethra. This helps relieve symptoms. TURP is the most common BPH procedure. But certain other procedures also help relieve BPH symptoms. Your doctor may do one of these instead of TURP. They include TUIP, TUNA, or laser ablation. If you will have one of these procedures, your doctor can tell you more about it. Your preparation and experience during surgery will be similar to TURP. 

Scheduling the surgery

Our surgery scheduler will make these arrangements for you:

  • Pre-operative lab work, EKG and chest x-ray as needed

  • Schedule the surgery at the hospital

  • Secure insurance pre-authorizations as required by your insurance

  • Schedule  pre-op appointments with our nurses and physicians

You are responsible for inquiring with your insurance company if you have additional expenses.

Surgeon Visit prior to surgery

This visit is usually within the two weeks prior to surgery. Your doctor will review the surgery and obtain your surgical consent.

Lab work/EKG prior to surgery

This is generally done 1-2 weeks prior to surgery and can often be done in the same visit as your pre-op surgeon’s visit. You do not need to fast for this lab work.  If you have any other medical problems (heart, lung, blood disorders) you may need to be evaluated further for surgical clearance – we will notify you if this is needed.

Prior to surgery

Your activity level, social calendar and/or work schedule need not be interrupted in the weeks prior to surgery. You want to be well rested and eat a nutritious diet prior to surgery. If you are a smoker, this is a good time to stop smoking. Please discuss smoke cessation treatments with us or your primary care physician.

 

 

Preparing for Surgery

  • For 7-14 days before surgery you must hold all aspirin, aspirin-containing products (Tylenol is okay) like advil or aleve, supplements and herbals. Please see blood thinning list included in the packet .  If you take Coumadin, or other medication to thin your blood, we need to know right away as arrangements with the prescribing physician may need to be made for an alternate medication. If you have had bleeding problems after any other surgery or procedure, please notify us right away. Please provide a complete list of all medications (prescribed and over the counter medications), dietary supplements, vitamins, minerals and herbal remedies to your surgeon.

  • If your doctor prescribes any medications, such as antibiotics, take them as directed.

  • The night before your procedure, do not eat or drink anything after midnight.  This includes gum, candy, and water.  If you were told to take medication the morning of surgery, take it with small sips of water.

  • Be sure to follow any special instructions you’re given.

  • The anesthesiologist often calls the night before surgery and may advise you differently of the fluids you can have the day of surgery. Take medications as you normally would with a sip of water, other than any blood thinning medications. If you are diabetic, consult with the surgeon for medication adjustments.  The anesthesiologist will see you in the pre-op area prior to surgery and review your medical history and anesthesia needs. The anesthesiologist administers medication and monitors your heart, breathing and blood pressure while you are asleep. The pre-op nurse will take vital signs and start an IV. If you or a family member has had problems with anesthesia in the past, please alert the anesthesiologist.

 

During the TURP Procedure

  • You will be given pain medication (anesthesia) to keep you from feeling pain during the procedure. It may be given to you through an IV (intravenous) line in your hand or arm. Or the medication may be injected into the fluid near your spine. These medications probably won’t put you completely to sleep. But you’ll be sleepy and feel no pain. In some cases, general anesthesia is used. This is to keep you sleeping throughout the surgery. The anesthesia doctor or nurse (anesthesiologist or nurse anesthetist) will talk to you about the pain medication that is best for you.

  • The doctor inserts a cystoscope (a thin, telescope-like tool) into your urethra. This tool lets your doctor see the blocked part of the urethra.

  • A tool is inserted through the cystoscope. This is used to remove the excess prostate tissue. The cut pieces of tissue collect in the bladder. The doctor then washes them out of the bladder with liquid.

  • The tissue pieces are sent to the lab to be sure they are free of cancer. 

  • A catheter may be inserted temporarily directly into your bladder to help your bladder drain.

Excess prostate tissue is removed during a TURP to let urine flow freely through the urethra.

 

Possible Risks and Complications of Prostate Procedures

  • Bleeding

  • Infection

  • Blood clots

  • Scarring of the urethra

  • Retrograde ejaculation

  • Erectile dysfunction (rare)

  • Absorption of fluid during the procedure (TURP syndrome)

  • Permanent incontinence (very rare)

Retrograde Ejaculation

After some surgical treatments, semen may travel into the bladder instead of out of the penis during ejaculation. This side effect is called retrograde ejaculation. As a result, there may be little or no semen when you ejaculate. This is harmless, and the feeling of orgasm won’t change. Retrograde ejaculation can also be a side effect of certain medications.

 

 

 

 

 

 

 

 

 

 

After Surgery

After surgery, you’ll first go to the recovery room, then to a regular hospital room. In some cases, you won’t go home until you can pass urine on your own or you go home with a catheter for later removal. The hospital stay is usually 1–2 days.

Image of patient

Having a Catheter

  • To cleanse your bladder and prevent blood clots, a catheter is placed in your urethra. Fluid then flows into and out of your bladder through the tube. The fluid draining from the tube will be reddish. This is nothing to worry about.

  • The catheter will usually remain in place for 1–3 days. While it is in, you may feel like you have to urinate. You may also feel cramps in your bladder. If the cramping bothers you or you are in pain, tell the nurse. He or she may be able to give you medication to help you feel better.

Urinating On Your Own

  • In 1–3 days after surgery, the catheter is removed. This is done to see if you can urinate on your own.

  • It is common to feel a burning sensation when you first pass urine. Also, the urine may still look reddish or pinkish. Tell the nurse if your urine is bright red.

  • The amount you urinate may be measured. In most cases, you will go home when you can pass urine without the catheter. If you can’t urinate on your own, you may go home with the tube still in place and a leg bag to collect the urine. In this case, you’ll return to the doctor later on to have the catheter removed.

Before Going Home

You will be told what to do while you heal. You may be given certain medications, such as antibiotics to prevent infection. Ask your doctor when you can start taking aspirin and other medications again. When you are ready to go home, have an adult friend or relative drive you.

 

Home Recovery

Take it easy for the first month or so while you heal. During the first few weeks, you may feel burning when you pass urine. You may also feel like you have to urinate often. These sensations will go away. If your urine becomes bright red, it means that the treated area is bleeding. This may happen on and off for a month or so after a TURP. If this occurs, rest and drink plenty of fluids until the bleeding stops.

Image of man and woman While You Are Healing

To help prevent problems during the first month after your surgery, follow these tips:

  • Drink plenty of fluids.

  • Avoid strenuous exercise.

  • Don’t lift anything over 10 pounds.

  • Avoid sexual activity and strenuous exercise.

  • Talk to your doctor about when you can return to work.

  • Ask your doctor when you can begin driving again.

  • Don’t sit for more than 60 minutes without getting up.

Follow-up Visits

You will visit your Urologist to make sure you are healing without problems. If tests were done on your prostate tissue(pathology evaluation to rule out prostate cancer) your doctor will discuss the results with you. For the 1st year after surgery, you will need to come to the visit with a full bladder so that a Uroflow can be performed. We will also obtain a PVR (post void residual) ultrasound and ask you to complete questionnaires about your symptoms. 

When to Call Your Urologist   303.825.8822

  • You’re not able to urinate, or notice a decrease in urine flow.

  • You have a fever over 100.4°F or chills.

  • You have severe pain that is not relieved by prescription pain medication.

  • You have bleeding that doesn’t stop within 12 hours.

  • You have bleeding with clots, or blood plugs up the catheter. (A little blood in the urine is normal.)

  • The catheter falls out.

 

Getting Back to Sex

BPH and its treatments rarely cause problems with sex. Even if you have retrograde ejaculation, orgasm shouldn’t feel any different than it used to. If you notice any problems with sex, talk to your doctor. Help may be available.

 

 

© 2000-2020 The StayWell Company, LLC. 800 Township Line Road, Yardley, PA 19067. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.