Questions To Ask Before Surgery
As you think over the options for surgery, ask your doctor these questions:
- Is there a good chance my condition will get better?
- How much will it improve?
- What are the chances of side effects from a treatment?
- How long will the effects last?
- Will I need to have this treatment repeated?
With newer technologies, doctors can do some minimally invasive procedures with tiny cuts or use tube-style instruments that they insert into you. These procedures may not treat the symptoms to the same degree or durability as more invasive surgical options, they do have faster recoveries, less pain afterward and have reduced risks.
Other times, the traditional and more invasive surgery may be needed. It all depends on your case and what you and your doctor decide is best for you.
Doctors can choose from these minimally invasive procedures, endoscopic, or open surgeries to treat moderate to severe symptoms. These procedures are also used if tests show that your ability to pee is seriously affected.
Transurethral Resection Of Prostate
Transurethral = through or across the urethra
Resection = cutting away or removal. Some people refer to it is scraping.
Incision = making a cut in
A special scope termed a cystoscope is placed in the urethra and guided into the bladder. The center portion of the prostate is identified. The obstructing prostate tissue is systematically resected until all of the obstructing tissue was removed.
In cases where the prostate is small and perhaps the problem is the increased tone of the prostate and bladder neck, we can do a more limited procedure. This would be an incision rather than a full resection. In this regard, the procedure is termed a TUIP instead of a TURP.
- Straining
- Hesitancy
- Slow or diminished force of stream
- Urine stream that starts and stops
- A sensation of incomplete emptying of her bladder.
Other symptoms that may be associated are what we call irritative symptoms. These symptoms include frequency of urination, urgency to urinate, and waking up at night to urinate.
There are other types of procedures that are available to treat your condition. These have been explained in your surgical consultation. The pros and cons of each with respect to your health and your particular prostate condition will have already been discussed. In the urologic literature, the TURP is still considered the gold standard operation to which the results of all lesser procedures need to be compared.
Preparation
Procedure
Post Procedure
Expectations of Outcome
Other Surgical Procedures For Prostate Disease
Alternative surgical procedures to TURP include:
- open enucleative prostatectomy this involves making a cut in the abdomen to remove a very enlarged prostate. This is the least common form of surgery. The average hospital stay is seven to 10 days
- laser TURP a laser is used to remove prostate tissue from the middle part of the prostate, which has the advantage of less bleeding and therefore safer for people on anti-coagulation therapy for other problems, including coronary stents, heart valve or vascular disease
- transurethral incision of the prostate similar to TURP except that no prostate tissue is taken out. One to three cuts are made in the prostate near the bladder neck to release the ‘ring’ of enlarged tissue and make a larger opening around the urinary tract
- UroLift® this technique is useful for men for whom medication has not been successful but their prostates are not so enlarged that they need a TURP. It involves the transurethral insertion of staples to separate the lobes of the prostate. It has minimal side effects and preserves ejaculatory and erectile function.
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Medication For Urinary Problems
Your doctor may suggest various medications to help ease your urinary problems, including:
- medications to reduce the tone of the muscles of the urethra and prostate to minimise any constriction to urine flow caused when these muscles contract
- medication to reduce the size of the prostate gland. These medications work by blocking the action of male hormones produced by the prostate gland
- medications to relax the bladder, making unwanted contractions less likely and reducing the symptoms of urgency and frequency of urination
- the over-the-counter preparation ‘saw palmetto’ is sometimes used. This may help some men, especially if frequent urination at night is a problem.
However, recent reviews of the evidence for using saw palmetto as a treatment for mild or moderate urinary symptoms did not show any improvement, compared to no treatment, in men with BPH.
Cost Of Enlarged Prostate Treatment Without Insurance
At New York Urology Specialists, we offer affordable treatment for men. Our prices are low for patients without insurance and for those who have high insurance copays, high deductibles, or insurance plans that do not cover treatment costs.
At New York Urology Specialists, we offer a flat-fee all-cost-included Rezum procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment. Please contact us for current prices and discounts for patients without insurance or with high insurance deductibles.
At New York Urology Specialists, we offer a flat-fee all-cost-included Urolift procedure. The procedure is performed in our office under local anesthesia. Men from other states can save thousands of dollars over local hospital fees by coming to New York Urology Specialists for treatment.
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Why Is This Important
An enlarged prostate can cause two main symptoms of the lower urinary tract: voiding and urinary retention. Prior to this research, some experts believed surgery did not help men with urinary retention. However, the trial found both prostate procedures are effective for treating both voiding symptoms and urinary retention.
Although previous research suggested that the laser procedure would lead to fewer complications and a reduced hospital stay compared to TURP, this was not seen in the study. The new findings from Bristol suggest hospitals who already perform TURP do not necessarily need to invest in equipment and training for the ThuVARP laser procedure. Patients can be reassured that either surgical option is safe and effective. The researchers say new treatment approaches should continue to be compared with TURP, as NICE guidelines recommend.
Why Is Turp Performed
Your urologist may recommend a TURP to treat an enlarged prostate due to the following conditions:
-
BPH , which is a noncancerous condition in which the prostate enlarges as a man ages. When the prostate gland grows, it presses against the urethra and bladder. This causes difficulty urinating, incontinence, , and incomplete emptying of the bladder.
-
, which causes , painful urination, painful ejaculation, and other symptoms. Sometimes a urologist may choose TURP to treat symptoms of prostate in older or ill men who cannot tolerate move invasive surgery to remove the prostate.
Your doctor may only consider A TURP for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a TURP.
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When To See A Doctor
Most people begin to feel better and have an improved urine flow within 4 to 6 weeks after TURP surgery.
Overall, the risk of serious complications after TURP surgery is quite low. But as with all surgeries, there are some potential health risks associated with the procedure that require medical attention and intervention.
Reasons to seek medical attention after TURP surgery include:
- bleeding from the urethra, outer prostate, or penis
- inflammation and pain in the urethra, prostate, or penis lasting longer than 2 weeks or worsening
- reduced urine flow or urinary symptoms, such as incontinence or urinary urgency 6 weeks post-surgery
- blood in the urine that is severe or lasts longer than 4 to 6 weeks
- severe clots of blood in urine or urine that is entirely red
- weakness and fatigue that does not improve after 4 weeks
- impotence or erectile dysfunction
Surgery To Remove The Inner Part Of The Prostate Gland
Prostate cancer can press on the tube that carries wee from the bladder. This can make it difficult for you to empty your bladder. Your doctor might suggest that you have an operation to remove some of the cancer so that you can pass urine more easily. This is called trans urethral resection of the prostate .
Surgeons can also use laser surgery to remove the prostate tissue. It works just as well as a TURP, but isn’t available in every hospital.
This operation is also for men with a non cancerous swelling of the prostate, also called benign prostatic hypertrophy .
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Transurethral Resection Of The Prostate
Expert reviewer, Dr Raj Persad, Consultant Urological SurgeonNext review due March 2023
Transurethral resection of the prostate is a surgical procedure for men that involves removing part of the prostate gland. Its used to treat a common condition where the prostate becomes enlarged, causing difficulty with passing urine. This is known as benign prostatic hyperplasia .
What To Be Careful About
Even though you have no visible incision and may have little pain, you are recovering from surgery. Don’t try to overdo it getting back into your normal activities. Discuss what to expect during recovering with your doctor. The following guidelines will help you have a smoother recovery:
- Avoid straining, especially when moving your bowel. Eat a balanced, high-fiber diet to prevent constipation. If constipation occurs, ask your doctor if you can take a laxative.
- Don’t do any heavy lifting.
- Avoid sudden movements.
- Drink plenty of water to flush the bladder and help prevent infection.
- Don’t drive or operate machinery.
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What Are The Symptoms Of Urinary Retention In Men With Bph
Symptoms of urinary retention and incomplete bladder emptying can vary substantially from person to person. Some men have minimal or no symptoms and are discovered to be in urinary retention only after a test such as a CT scan or ultrasound of the abdomen reveals a full bladder.
More commonly, men may experience a slow urine stream, frequent urination during the day and at night, discomfort in the perineum or lower abdomen, and sensation of incomplete bladder emptying and urinary urgency. Sometimes men report fatigue caused by renal insufficiency as a result of urine retention.
Occasionally men may have frequent urination and urinary overflow incontinence caused by overfilling of the bladder with high pressure.
What Happens During Turp
TURP requires a hospital stay. Procedures may vary depending on yourcondition and your healthcare providers practices.
Generally, a TURP follows this process:
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Holep Rezum And Urolift
Surgical treatments for benign enlargement of the prostate are an option for men with troublesome symptoms who have not had satisfactory results after trying prostate medication, or who do not wish to remain on longterm medication for their prostate condition. Surgery is also used to treat men suffering from urinary retention who are unable to pass urine and are dependent on a catheter to empty their bladder, and for men who have repeated urine infections or bleeding due to their enlarged prostate.
REZUM is the new minimally invasive treatment that uses steam vapour to shrink the prostate and improve urinary symptoms. It is carried as day case and patients are able to return normal daily activity within a few days.
Uro Lift is a new minimally invasive treatment for men with urinary symptoms due to minimal- moderate enlargement of the prostate. It is performed from within the urethra and involves pinning back rather than removing the obstructive prostate tissue. It is not suitable for all men with urinary symptoms and is as yet unproven in the treatment of men with urinary retention. Advice from a specialist urologist, such as those in the Cambridge Urology Partnership, is advised in order to determine whether UroLift might be suitable for you.
Inflammation Of The Prostate Gland
Bacteria sometimes cause prostatitis . More commonly, the underlying cause is uncertain. Consult your doctor promptly if you experience:
- fever
- pain in the groin
- urgent and frequent urination.
Treatment with antibiotics is essential for acute bacterial prostatitis. Admission to hospital is often necessary and, as with chronic bacterial prostatitis, specific antibacterial drugs are required for a long time.
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How Is A Turp Performed
The operation is performed under general or local anaesthesia. It is performed through a telescope passed up the pipe of the penis, and therefore there are no external cuts or scars. An electrical loop is used to cut away small parts of the central portion of the gland, until there is a wide cavity with no obstructing tissue. The pieces of the prostate are sent away to the pathologist for examination. When I have finished the operation, I pass a catheter in to the bladder, which drains the urine and helps to wash away any blood. This catheter stays in for 24-48 hours.
Side Effects Of Conventional Prostate Bph Treatments And Enlarged Prostate Surgery
If you are very lucky you may well have an improved urinary function and few side effects after enlarged prostate surgery. Unfortunately, that is not the case overall.
If you think that BPH operations are harmless, think again. In my experience, side effects are not fully explained and are minimized. Why? Because doctors:
- think they are providing the best treatment based on what they know and what they have available to offer,
- often directly benefit financially from the procedures, and
- are unaware of any other options.
If they do know of alternative options, they could risk losing their medical license by offering those alternative treatments.
All of the conventional treatment options I mention on this page have consequences of:
- major discomfort to pain
- possible incontinence
- impotence and sexual difficulties
- retrograde ejaculation
- and often the treatment will need to be repeated at a future date with scarring occurring with each attempt, which makes each procedure less successful and exacerbates the side effects.
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Prostate Size And Blockage Of The Urethra
If the inner part of the prostate gland obstructs the urethra during urination, this will irritate the bladder and cause urinary symptoms.Urinary symptoms may include:
- frequent urination, particularly at night
- urgency and possible urgency incontinence
- passing drops of urine involuntarily after you think you’ve finished
- blood in the urine although this can never be assumed to be due to the prostate until other causes have been excluded.
The actual size of the prostate does not appear to determine whether or not there is a blockage. Some men with large prostates never develop obstruction, but some men with small prostates can have severe bladder obstruction, which causes difficulty with urinating.Around one in three Victorian men over the age of 50 years have some urinary symptoms. In most cases, these symptoms are due to a blockage caused by an enlarged prostate, but they may be due to other causes.
Benign Enlarged Prostate: What Are The Pros And Cons Of Surgery
Surgery can very effectively reduce the problems associated with a benign enlarged prostate. It is considered if other treatments don’t provide enough relief, or if the enlarged prostate keeps causing medical problems such as urinary tract infections. But surgery often has side effects.
Most men who have a benign enlarged prostate aren’t in urgent need of surgery. They can take their time to carefully consider the pros and cons. There are various possible reasons for deciding to have surgery. For instance:
- The prostate-related problems may be very distressing, and other treatments may not have led to a big enough improvement.
- The enlarged prostate may frequently cause other medical problems, such as recurring urinary tract infections or bladder stones.
- Treatment with medication may not be possible for medical reasons.
The decision will also greatly depend on how the man feels about the potential benefits and harms of a procedure. Although surgery is very effective, it can lead to complications such as ejaculation problems.
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