What Is Transurethral Resection Of The Prostate

What You Can Expect

The TURP procedure takes about 60 to 90 minutes to perform. Before surgery you’ll be given either general anesthesia â which means you’ll be unconscious during the procedure â or spinal anesthesia, which means you’ll remain conscious. You might also be given a dose of antibiotics to prevent infection.

Enhancing Healthcare Team Outcomes

TURP is typically an elective procedure used in the treatment of BOO. Because of this, appropriate indications and discussion of the complications associated with the procedure require an integrated interprofessional team to communicate effectively and initiate treatment plans, so the patient has proper expectations. This approach will ensure that patients are prepared for their procedure and what to expect. When patients are better informed, they are more invested in their decision and are happier with their outcome.

Collaboration shared decision making and communication are key;elements for a good outcome. The interprofessional care provided to the patient must use an integrated care pathway combined with an evidence-based approach to planning and evaluation of all joint activities. The earlier signs and symptoms of a complication;are identified, the better is the prognosis and outcome of the procedure.

What Are The Risks And Complications Of Turp

The main risk is to your sex life.

Some men have problems getting an erection after surgery. For some men, that lasts a few months. In about 1 in 10 men, erectile problems are permanent.

Between half and three-quarters of men have permanent problems with ejaculation after a TURP. Usually the problems arise from the semen flowing backwards into the bladder during ejaculation this is known as retrograde ejaculation. Although it is not life threatening, it can cause infertility in couples and can change the sexual experience for men.

Other problems such as bleeding, infection, frequency of urination and urgency can occur. Occasionally, a man develops urinary incontinence after a TURP.

Its important to talk to your partner and your doctor about the impact this surgery might have on your sex life, and to look at alternatives.

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What Are The Alternatives To Turp

If you have an enlarged prostate, there are a number of options, including:

• do nothing some men will find the symptoms get no worse
• take medicines
• laser therapy, using heat to remove tissue from the prostate
• microwave treatment, using microwave energy to shrink the prostate
• other operations, such as transurethral incision of the prostate or open or retropubic prostatectomy

You should think about the benefits and risks of all approaches.

How Do I Prepare For My Turp

You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.

You can prepare for TURP by:

• Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and at all times.

• Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a , EKG , blood tests, and other tests as needed.

• Losing excess weight before the surgery through a healthy diet and exercise plan

• Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.

• Stopping as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.

• Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen , and blood thinners.;

Questions to ask your doctor

Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctors office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.

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How Long Will It Take Me To Get Back To My Daily Activities

Usually, you can leave the hospital 2 or 3 days after surgery. The length of hospital stay can vary in different countries. There may be some blood in your urine for several days. You may also suffer from urgency and feel pain when you urinate, which can last up to several weeks.

For 4-6 weeks after the surgery:

• Drink 1-2 litres every day, especially water
• Do not lift anything heavier than 5 kilograms
• Do not do any heavy exercise and avoid bike riding
• Do not take thermal baths or go to the sauna
• Prevent constipation by adapting your diet
• Discuss any prescribed medication with your doctor

Avoid having sex for 2-3 weeks. After TURP, you may suffer from retrograde ejaculation. This is a chronic condition where semen can no longer leave through the urethra during orgasm. Instead, it goes into the bladder and later leaves your body during urination.

You need to go to the doctor or go back to the hospital right away if you:

• Develop a fever
• Are unable to urinate on your own
• Have heavy blood loss or pain

Transurethral Resection Of The Prostate : Home Recovery

Take it easy for the first month or so while you heal after transurethral resection of the prostate. 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.

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What Are The Side Effects

Initially, the urethra and surrounding area will be inflamed, and it will be difficult to urinate. The catheter and flushing process can also be uncomfortable and cause bladder cramping.

The urethra, penis, and lower abdominal area will be tender, red, and swollen for a few weeks after surgery, which can interfere with urination. Most people also feel very weak and tire easily for several weeks.

Common side effects of TURP surgeries include:

• difficulty completely emptying the bladder
• urinary urgency or the sudden urge to urinate
• discomfort during urination
• small dribbles or clots of blood in the urine, for up to 6 weeks

The minor side effects associated with TURP surgeries usually go away as the urethra and prostate tissues become less inflamed, usually within a few weeks.

Though TURP surgeries may or may not be associated with erectile difficulty in some people, they can decrease the volume of semen produced during ejaculation.

As with any medical procedure, especially those involving anesthesia, the surgery for BPH is associated with some medical complications.

Possible but rare risks associated with TURP procedures include:

• excessive bleeding

How Does The Procedure Work

After anesthesia, a surgeon will insert a tool called a resectoscope into the urethra. In some cases, a separate device will be used to flush sterile fluid through the surgical site.

Once the surgeon has positioned the resectoscope, they will use it to cut away abnormal prostate tissues and seal broken blood vessels.

Finally, the surgeon will insert a long plastic tube called a catheter into the urethra and flush destroyed prostate tissues into the bladder where they are excreted through urine.

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When To Call Your Healthcare Provider

• Youre not able to urinate, or notice a decrease in urine flow

• You have a fever of;100.4°F or higher, or as directed by your doctor

• You have severe pain that is not relieved by prescription pain medicine

• You have bleeding that doesnt stop within 12 hours

• You have bleeding with clots, or blood plugs up the catheter.

• The catheter falls out

Less Common Side Effects Of Turp

Less common unwanted effects of surgery include:

• urinary symptoms do not change sometimes surgery does not cure your urinary problems. Even though the blockage has been cleared, the bladder irritability may continue and you may still have symptoms such as being unable to empty your bladder completely, and nocturia
• erectile dysfunction some men are unable to get or maintain an erection sufficient for sexual intercourse after surgery. This is more of a problem for men who had erectile difficulties before their operation. This problem may be treated by medication
• urethral strictures when scarring occurs in and around the urinary tract, it can cause further blockage to urine flow. Strictures may need to be dilated or need further surgery
• urinary incontinence sometimes surgery results in being unable to hold or control the flow of urine. This may be due to continuing bladder problems or, less often, to sphincter muscle damage
• infertility retrograde ejaculation is not harmful, but it can result in infertility. It causes the seminal fluid to collect with the urine and it doesn’t come out as ejaculate. This makes ‘natural’ insemination impossible. However, in vitro fertilisation may be used to achieve a pregnancy. The sperm can be removed from the urine and injected into the womans harvested eggs.

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Getting Ready For The Operation

If you smoke, try and cut down or preferably stop, as this reduces the risks of heart and chest complications during and after the operation. If you do not exercise regularly, try and do so for at least half an hour per day e.g. brisk walk or swimming.

You will be given a form to have routine pre operative blood tests and a urine test to exclude infection before your surgery if you have lost your a form please contact Dr Nathans rooms.

If you are on medication to thin the blood such as warfarin, aspirin, Plavix, Iscover, Brilinta, Pradaxa, Xarelto or supplements such as fish oils please let Dr Nathan know at least 2 weeks before surgery as these medications may need to be discontinued to prevent excessive bleeding at the time of surgery. You can continue to take your other medications as normal.

Speak to the anaesthetist about your anaesthetic

Transurethral Resection Of The Prostate Side Effects

what are the side effects?

Transurethral resection of the prostate is a surgery used to treat urinary problems due to an enlarged prostate.

• Urinary tract infection.;This type of infection is a possible complication after any prostate procedure. An infection is increasingly likely to occur the longer you have a catheter in place. Some men who have TURP have recurring urinary tract infections.
• Dry orgasm.;A common and long-term effect of any type of prostate surgery is the release of semen during ejaculation into the bladder rather than out of the penis. Also known as retrograde ejaculation, dry orgasm isn’t harmful and generally doesn’t affect sexual pleasure. But it can interfere with your ability to father a child.
• Temporary difficulty urinating.;You might have trouble urinating for a few days after the procedure. Until you can urinate on your own, you will need to have a tube inserted into your penis to carry urine out of your bladder.
• Erectile dysfunction.;Up to 10% of men who have a TURP have;difficulty getting and maintaining an erection ;afterwards. This can be either temporary or permanent.

Medication can be prescribed to help reduce the problem if necessary, but you should speak to your surgeon if this is a concern. Your surgeon may be able to provide more information on your individual risk.

10 common questions about transurethral resection of the prostate

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Surgical Alternatives To Turp

Surgical alternatives to TURP are designed to decrease blood loss, inpatient hospitalization, and fluid absorption, while still removing or destroying the obstructing prostatic tissue. These include transurethral vaporization of the prostate , bipolar TURP, photoselective vaporization of the prostate , and holmium laser enucleation.

Reports comparing these various prostatic ablative techniques by Van Melick et al, Eaton and Francis, and Gilling et al show that they all demonstrate improvement that is roughly equivalent to TURP in terms of urodynamics, symptom scores, and uroflowmetry parameters for at least 7 years.

Noble and colleagues compared these techniques in a randomized, controlled trial from a strictly economic point of view. They concluded that noncontact laser therapies tended to be the most costly surgical treatment option, while TURP was the most cost-effective.

Electrovaporization of prostate

Electrovaporization of the prostate uses a ridged or pitted cylindrical metal roller electrode instead of the standard wire loop. This roller electrode conducts the electrical cutting current at very high energy levels, resulting in complete vaporization of the prostatic tissue it contacts. This method results in relatively good hemostasis with less bleeding and fluid absorption than the standard TURP.

Bipolar TURP

Holmium enucleation of prostate

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.

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Why Might I Need Turp

TURP is most often done to relieve symptoms caused by an enlarged prostate.This is often due to benign prostate hyperplasia . BPH is not cancer.It is a common part of aging. When the prostate gland is enlarged, it canpress against the urethra and interfere with or block the passage of urineout of the body.

Sometimes a TURP is done to treat symptoms only, not to cure the disease.For example, if youre unable to urinate because of prostate cancer, butsurgery to remove the prostate isnt an option for you, you may need aTURP.

There may be other reasons for your healthcare provider to recommend aTURP.

How Turp Is Performed

TURP is carried out using a device called a resectoscope, which is a thin metal tube containing a light, camera and loop of wire. This is passed along your urethra until it reaches your prostate, which means no cuts need to be made in your skin.

The loop of wire is then heated with an electric current and used to cut away the section of your prostate causing your symptoms. A thin tube called a catheter is then inserted into your urethra;to pump fluid;into the bladder and flush away pieces of prostate that have been removed.

General or spinal;anaesthesia;is used during the procedure so you don’t feel any pain while it’s carried out.

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Immediately After A Prostatectomy

After the operation, you can expect that:

• Nurses will monitor your vital signs.
• You may be given oxygen for up to 24 hours following surgery.
• You will probably be given antibiotics to prevent infection.
• For a day or so, you will have a catheter in your urethra and bladder with a continuous wash-out. This is to prevent blood building up and clotting, which could cause a blockage.
• If you had an open prostatectomy, your wound will be dressed and you will have a tube draining your abdomen. The tube will be removed after several days.;
• Pain will be managed with injections, tablets or both. Pain is rarely a significant problem following TURP.

What Are The Risks And Potential Complications Of A Turp

As with all surgeries, a TURP involves risks and possible complications. Most TURP procedures are successful, but complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.

General risks of surgery;

The general risks of surgery include:;

• Anesthesia reaction, such as an and problems with breathing

• Bleeding, which can lead to shock

• , in particular a that develops in the leg or pelvis. A DVT can travel to your lungs and cause a .

• Infection;

• Abnormal flow of semen into the bladder instead of out the urethra

• Damage to nearby organs and tissues including the urethra, bladder or rectum

• Damage to tissue around the prostate due to buildup of fluid

• , which is problems having or keeping an erection

• Infertility

• Scar tissue on the urethra, which could tighten the urethra and cause a urethral narrowing, or stricture, making it difficult to urinate

• Urinary or bowel incontinence

Reducing your risk of complications

You can reduce the risk of certain complications by following your treatment plan and:

• Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery

• Notifying your doctor immediately of any concerns, such as bleeding, , fever, increase in pain, or decreased urination

• Seeing your doctor as instructed before and after surgery

• Taking your medications exactly as directed

• Telling all members of your care team if you have any allergies

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How The Turp Is Performed

The TURP itself has gone through several improvements over the years, brought on in large part by competitive pressure by lasers used for the same purpose such as the Greenlight laser, or Holmium laser . Now, a TURP is done via continuous flow, using bipolar electrical current. This allows the surgeon to use saline as an irrigant rather than water, and this has dramatically increased our ability to offer a bipolar TURP to patients with larger prostates allowing for longer resection times and far fewer complications. A bipolar TURP is the preferred OR procedure of the surgeons at Urologic Surgeons of Washington, with benefits that far outweigh those provided by the various laser vaporization;systems currently marketed.