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TransURethral Prostatectomy (TURP)

(Standard Prostate Operation)

What is prostate?

The Prostate is a walnut shaped gland, which is around the neck of the bladder, enclosing the urethra (also called the water pipe).

Why do I need an operation?

As men get older, the prostate gland enlarges. This causes minor problems such as passing urine more frequently, having a poor stream, and getting up to pass water in the night.

Sometimes it can cause a total blockage, so no urine can be passed, if the problem hasn’t been detected earlier.

An operation is then necessary, to remove part of the prostate gland to allow a free passage of urine.

What preparations should be made?

Although the operation usually takes only 45 minutes, pre-operative checks are needed. The blood tests, urine tests, x-rays and ECGs (electrocardiograms) may be done a few weeks before your admission to hospital, to check that your general health is satisfactory. If not, these checks will be made on the day before your surgery. You will stay in hospital between 5-6 days, on average, though in very elderly patients, this may be longer.

The operation

Almost all prostate operations are carried out transurethrally. This means that a telescopic instrument is inserted into the bladder via the urethra (the tube from the bladder through which urine is passed to the outside) throughout the length of the penis. The surgeon can see the enlarged prostate and uses an electric current (diathermy) to remove the prostate in small pieces. The pieces of prostate are removed through the same instrument at the end of the operation.

A general anaesthetic is usually needed, although a spinal or epidural anaesthetic (regional anaesthetic), which “deadens” the area being operated on, may be possible.

At the end of the operation, a catheter tube is placed in the bladder, coming out from the end of the penis. This drains blood and urine from the bladder, and will remain in place for 24-48 hours after the operation. It doesn’t cause any pain, but can be uncomfortable when moving around. The catheter tube is usually removed on the second or third day after the operation.

You will remain in hospital for a further 12-24 hours, to ensure that all is well, before going home. At this stage, your urine may still be bloodstained, and you may feel you need to pass urine very urgently. Both these are very common, and will subside over the next two to six weeks.

Throughout your stay in hospital, it is important to drink at least 5 to 6 pints of fluids every day, to ensure a better flow of urine.

Are there any complications?

TURPs are carried out very frequently, and have a low complication rate. A little bleeding, and a stronger than usual desire to pass urine are quite common in the first six months after the operation. You may also have some discomfort on passing urine for two to six weeks. The full benefits of the operation may not be felt for about 2-3 months.

Excessive bleeding sometimes occurs immediately after the operation, and can be treated with a blood transfusion. A second operation to stop the bleeding is seldom needed. The bladder may need to be flushed through with fluid to wash out blood clots.

Failure to pass urine properly, when the catheter is removed, may be due to a blood clot, or to a remaining piece of prostate. The catheter will then need to be replaced, and sometimes a further operation is necessary. Inability to control the flow of urine is very rare after a prostate operation, but can happen. This is difficult to treat, but not impossible.

What about when I get home?

You will be able to get back to your normal activities slowly, as you feel better. Please continue to drink at least 2-3 pints of fluid each day for the first two weeks at home.

Don’t drive for two weeks, and avoid any heavy lifting and strenuous activity such as gardening carrying heavy shopping bags, golf, and bowls etc. for six weeks.

What about work?

If your job does not involve any heavy lifting, you may go back to work after 2-4 weeks. If your job is demanding, and involves a lot of lifting, you shouldn’t go back to work for 6 weeks.

Will a TURP affect my sex life?

When you resume sexual activity, you will probably notice that the semen is no longer emitted from the end of the penis. The sensation of orgasm is present, but altered, as the semen is ejected backwards into the bladder. Because of this, it may not be possible to father children, although the performance of the sexual act should not be altered.

The ability to get an erection will very occasionally be affected by a prostate operation. At present, urologists are unable to predict which patients will have this problem. If you have any problems getting or sustaining your erection, please see your doctor, as he/she will be able to discuss treatment to improve the quality of erections and help improve your sex life.