information for patients
Surgery of the Prostate
(Trans Urethral Prostatectomy or TURP)
Your consultant has diagnosed that you have
a problem with your prostate gland and has
recommended that you have an operation
called TURP (Trans Urethral Prostatectomy).
This means that part of the prostate gland is
removed.
This booklet contains some of the questions
you may want to ask about your operation. It
will help you to understand the operation and
the care that you will receive.
If you want to know any more information
about the prostate and what the operation
involves, please speak to one of the doctors
or nurses. They will be more than happy to
help.
Kidney
Ureter
Bladder
Prostate
Uretra
Testes
The urinary tract and the prostate
gland
Your kidneys filter waste chemicals from the
blood to form urine which passes into the
kidneys’ collecting systems and then on to the
ureter and bladder.
The bladder is a hollow muscular balloonlike organ that collects urine which it stores
until you are ready to urinate. The tube
from the bladder to the outside world is
called a urethra. It passes through the
prostate gland and along the penis. The
urethra is surrounded by a muscle called a
urethral sphincter. When your bladder is
storing urine the sphincter muscle
compresses the urethra and keeps you
continent by preventing urinary leakage.
When you urinate your bladder muscle
contracts (squeezes) and the sphincter
muscle relaxes (opens) and urine is expelled
along your urethra.
The prostate is a gland situated at the base
of the bladder and surrounds the urethra.
Although it can cause problems with
urination as you get older it has no function
in normal urination. The purpose of the
gland is to produce a fluid which is important
for sperm function. After you have had a
family, it serves no useful purpose. The best
way of describing it is to imagine it is like an
apple with the core removed.
What problem do I have with my
prostate?
The prostate tends to grow as men get
older. In some cases, it becomes large
enough to put pressure on the urethra,
narrowing it. The narrowing leads to
symptoms such as delay in starting to pass
urine and passing urine very slowly with
stops and starts. Sometimes, if the
narrowing causes a complete blockage you
may not be able to pass urine at all.
The bladder muscle has to squeeze harder to
force urine through the narrowed urethra and as
a result can become overactive. This over activity
may cause the symptoms of having to pass urine
frequently and urgently, getting up in the night to
pass urine and sometimes even loss of bladder
control causing incontinence.
What are the benefits of having an
operation to remove part of my prostate?
A TURP removes the narrowing or blockage
caused by the prostate.
Rarely, it is also possible to develop a blood clot
(known as a deep vein thrombosis or DVT) in
the veins of the leg. This clot can break off and
travel to the lungs to cause a blockage. In the
majority of cases, this is treatable, but it can be a
dangerous condition. People having surgery are
routinely given medicines or compression
stockings to wear during the operation to help
prevent a DVT.
There are also a number of specific side effects
that you need to be aware of:
The operation should improve your symptoms
considerably. In particular, you will notice an
improvement in the force of your urine stream
within a few days. Your other symptoms, due to
bladder over activity, may take longer to improve
and it may be several months before you feel the
full benefit.
There is a definite chance (50% or more) that
you will experience retrograde ejaculation after
the operation. This means that during orgasm,
instead of ‘squirting’ out in the normal way,
semen passes backwards, up the urethra, into
the bladder and is later passed out with the
urine - making the urine appear cloudy.
It is important that you realise the operation
should improve your symptoms, but it may not
cure them completely. Your bladder will not
return to what is was 20 years ago. For example,
you may still find that you have to get up once or
twice in the night to urinate. This is quite normal
as you get older.
This happens because a muscle at the neck of
the bladder is partly cut during the operation.
This muscle usually contracts at the moment of
ejaculation and prevents the semen passing into
the bladder. In many cases it will not be able to
perform this function once the TURP operation
has been carried out.
Are there any risks involved in having
prostate surgery?
Most people get through their operation with no
problems and are very pleased with the results.
However, it is important to realise that
sometimes there can be difficulties.
Retrograde ejaculation will not do any harm, but
the sensation of an orgasm may be different.
Some people get little or no benefit from having
the operation and are left with the same
symptoms as before.
The operation can affect your ability to have an
erection and a small proportion of men (approx
10%) become impotent afterwards.
Very few people (less than one per cent) can
become critically ill as a result or the operation usually as a result of heavy bleeding or severe
infection. It is also possible for too much water
to be absorbed from the fluid used to flush the
bladder during the operation. This can
temporarily upset the balance of salts in the blood
which can be harmful, particularly for people who
already have heart or kidney problems. The
condition is very rare and known as TURP
syndrome.
Finally, there is a very small risk (less than one
percent) that the operation can cause permanent
incontinence.
There is also a risk of infertility, but this is not
usually a problem for men in the age group who
normally have prostate surgery.
A minor degree of incontinence immediately
after the operation is not unusual, but it almost
always settles down.
If you are worried about any of the risks listed
here, please talk to a doctor or nurse.
What are the alternatives to a TURP?
No treatment - if you choose to have no
treatment your symptoms are likely to get slowly
worse over time but you are not at a greater risk
of developing a major health problem than if you
had no treatment.
Herbal remedies - Saw palmetto extract is one
of several herbal remedies that some men find
helpful. There is some scientific evidence that it
may be a beneficial treatment for men with
enlarged prostate glands.
Medicines - These need to be taken daily, to
improve the flow of urine and/or shrink the
prostate and are more effective than herbal
remedies.
Getting ready for the operation
We run a pre-assessment clinic which you will
probably have been asked to come to during the
weeks before your operation. The idea of this
clinic is to do much of the administration and
investigations required for the operation before
you come in. This helps to shorten the time you
have to spend in hospital before the operation
and allows us to identify any potential problems
(such as high blood pressure) in time for them to
be sorted out beforehand.
Tests may include:•
•
•
•
•
Taking a sample of urine to check that you
have no infection
Blood samples
ECG (heart tracing)
Weight/height
Temperature, pulse and blood pressure
You will be seen by a nurse, and a consultant will
discuss your surgery and ask you to sign a
consent form. At any stage please feel free to ask
questions about anything you do not fully
understand or are concerned or worried about.
Your anaesthetist will see you in the preadmission clinics or on the ward when you come
in. She/he will explain the details of the
anaesthetic to you. See ‘What sort of
anaesthetic will I have?’ Later on in the
booklet.
The nurse will inform you when to come in to
hospital and where to report and also when to
stop eating and drinking.
Note: If you do not need to attend the preassessment clinic your documentation and
investigations will be carried out on the day of
your admission to hospital.
What happens on the day of the
operation?
The nurse will prepare you for theatre and help
you to put on a theatre gown.
If the anaesthetist has requested it you will be
given pre-medication (usually in the form of
tablets). After this you will be asked to remain
on your bed as you may begin to feel sleepy.
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.
You will be taken to theatre reception by a
nurse and a theatre porter. The theatre nurse
will check your details and escort you into the
anaesthetic room.
What sort of anaesthetic will I have?
You may have a spinal or a general anaesthetic.
A general anaesthetic means that you will be fully
asleep whilst the operation is carried out. In a
spinal anaesthetic, you are given an injection in
your back, which completely numbs the lower
half of your body and stops you from feeling any
pain. However, you will still be awake and
aware of your surroundings.
The choice of anaesthetic will be made by the
anaesthetist, because for some patients, one
technique may have advantages over the other.
If there is no particular medical reason to
recommend one method, the anaesthetist will
usually offer you the choice.
What is the operation?
The operation itself takes about an hour and
removes part, not all, of the prostate gland. It is
carried out by passing a rod-like instrument
called a resectoscope up the urethra and into
your bladder.
The resectoscope includes a camera and specially
adapted surgical instruments that allow the
surgeon to see inside clearly and perform
operations. A wire loop attachment that carries
an electric current is used to ‘chip away’ at the
prostate. By removing many pieces or chips, the
size of the urethra can be enlarged - rather like
re-boring a pipe or coring an apple. 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 chips of prostate
tissue. A catheter (a thin flexible tube) is then
inserted through the urethra into the bladder.
An advantage of surgery through the urethra is
that there is no external wound, enabling you to
move around more quickly and easily after your
surgery.
All the tissue removed from the prostate is sent
to the laboratory for examination.
What should I expect after the operation?
When the operation is over you will spend a
short time in the recovery room until the ward
nurse collects you and takes you back to the
ward. You will have your blood pressure, pulse
and breathing checked regularly by the nurse.
You will have a drip running into a vein in your
arm which will maintain your body fluids until you
are eating and drinking again.
There a catheter going up the urethra into your
bladder to drain away urine and blood. There
may also be an irrigation solution running through
the catheter to flush out blood from the bladder.
The irrigation will be stopped in a day or so. A
drainage bag is attached to the catheter and you
may find that the fluid draining looks very
bloodstained. This is normal.
As the anaesthetic wears off, there may be some
pain and the anaesthetist may prescribe
painkillers.
If you start to feel uncomfortable, as if you
urgently need to pass urine, the catheter maybe
blocked and you need to tell the nurse straight
away so that the blockage can be relieved.
Visiting on the afternoon of the day you have
been to theatre is not advised. A relative or
friend is welcome to visit in the evening.
The day after the operation, you can usually get
out of bed and walk around. You should be able
to eat and drink normally. You may seem a
little tired, so it is advisable to have plenty of
rest during the next few days.
The catheter will be removed when your urine is
pale pink in colour, usually one or two days after
the operation. In order to make sure your urine
clears quickly you should drink one or two
glasses of fluid every hour.
Occasionally, it is not possible to pass urine after
the operation. If this happens, a catheter will be
put back into your bladder and you will go home
with the catheter in - usually for about two to
four weeks. At the end of this time you will
come back to hospital and have the catheter
removed.
You should then be able to empty your bladder
without difficulty.
How long will I have to stay in hospital and
when can I go home?
A TURP usually involves a hospital stay for
around two to three days but a few patients stay
in hospital between five and seven days.
You will be able to go home after your catheter
has been removed and if:
•
•
•
Your urine is clear enough
You can pass urine with good control and
you are emptying your bladder completely
(this may be checked using a bladder
scanner)
You have a normal temperature
What should I do when I get home?
Once home, further painkillers may be taken if
needed, as advised by the hospital. Drinking at
least two litres of fluid a day will help flush out
the bladder and assist recovery. It is common to
have occasional blood clots (red-brown or
purple flecks) in the urine. Also leaks of urine
can happen when coughing or straining for a
number of weeks. To help with this an
absorbent liner can be worn inside the
underpants.
information for patients
What should I do if I have problems at
home?
It is quite normal to see a little blood in your
urine for up to four weeks after your surgery.
As with any wounds, scabs form and
eventually drop off, causing minor bleeding
after your surgery. If this happens make sure
you drink plenty of fluids to flush and dilute
the blood. If bleeding persists for more than
48 hours then you should contact your own
GP.
If you experience pain on passing urine, or
have a temperature, you have a urine
infection and again you need to contact your
GP. He/she may give you a course of
antibiotics.
Your GP should be contacted immediately if
heavy bleeding returns, there is a high
temperature, if it’s not possible to urinate or
if the level of pain increases.
You may continue to pass urine rather
frequently for a time. This should gradually
improve over the next five to six weeks.
When will I be able to go back to work?
This depends on the type of work you do, but
as a rough guide light jobs may be resumed
after four weeks. Heavy jobs should be
avoided for at least six weeks. Your GP will
advise you.
What exercise can I do?
Strenuous exercise such as gardening,
decorating, heavy lifting, golf and dancing,
should be avoided for two weeks. You can
then increase your exercise as you feel able.
The speed of recovery can vary greatly
between patients, but as a rough guide, you
should be more or less back to ‘normal’ after
four to six weeks. Gentle walking and
swimming are beneficial and may be
undertaken immediately.
Will I be able to drive?
Driving is best avoided for a few days after
you get home. You may drive short
distances when you feel comfortable,
normally alert and able to do so. Driving for
long distances should be avoided until you
have completely recovered.
When can I have sex?
Sexual activity should be avoided for four
weeks. Sex earlier than this can trigger
bleeding from the raw area left in the
prostate. Do not be surprised if you do not
feel like having sex for longer than this. It is
quite normal.
General things to remember…
•
If you think you may have an infection
or feel ill, contact your own GP
•
If you have been given antibiotics,
make sure you complete the course
•
If you are unsure about the tablets
given to you contact your GP for
advice
•
Do not strain to pass stools, if you
become constipated contact your GP
•
If the blood in your urine increases
and you are worried, contact your GP
•
If you have any problems or are
unsure what to do please do not
hesitate to contact any of the ward
staff for advice.
We hope you have found this information
useful. If you have any questions, or are
worried about anything, please speak to your
GP or contact Barnes Ward at Chesterfield
Royal Hospital on 01246 512452.
Surgery of the Prostate (TURP): February 2013
Next Planned Review date: February 2017
Directorate: Surgical Specialties (Urology)