Transurethral Resection of the Prostate (TURP) (Part Two)

Risks

Possible risks include:

• Bleeding. In some cases, bleeding may be so significant that a blood transfusion is required. This is rare. Patients with a large prostate are at higher risk of bleeding.
• (Decrease in sodium Na level) in the blood. This rare complication is called TURP syndrome. It occurs when the body absorbs too much of the fluids used to irrigate the surgical field during the procedure. If TURP syndrome is not treated, it can be life-threatening. To reduce the risk of TURP syndrome, a new technique called bipolar TURP is used which allows the use of a saline solution for irrigation during the procedure.
• Temporary difficulty in urination. After the procedure, there may be difficulty or an inability to urinate for some days. Until the patient is able to urinate on their own, they need to keep a catheter in the bladder through the penis (urinary catheter) to drain the urine.
• Urinary tract infection. Urinary tract infections are possible complications after surgical procedures for BPH. An infection can occur when the catheter is kept in for too long and may require treatment with antibiotics or other treatments.
• Difficulty in holding urine. It is rare for bladder control (incontinence) to be compromised; this is a long-term complication of TURP.
• Dry orgasm. TURP can cause retrograde ejaculation, meaning that the sperm released during sexual activity (ejaculation) goes back into the bladder instead of coming out through the penis. Retrograde ejaculation is harmless and generally does not affect sexual satisfaction but affects the ability to have children. This long-term side effect occurs in 75% of men who have undergone TURP.
• Inability to achieve an erection. One of the long-term complications of TURP is the inability to achieve an erection (penis erection). This can happen but is not common.
• Need for retreatment. Some patients need treatment after TURP, either because symptoms have reappeared over time or because they never improved. This is encountered less frequently in TURP than in some other less invasive methods performed in outpatient settings. In some cases, there may be a narrowing of the channel (urethra) or of the bladder neck which requires further treatment.

Preparation

Before preparation, the doctor may want to look inside the urethra and bladder using a cystoscope. This determines the size of the prostate and examines the urinary system. At the same time, the doctor may request other examinations such as blood tests, or examinations that determine the size of the prostate, urine flow.

Issues to be discussed with the doctor before the procedure.

• The medications you use. The doctor should be informed about all medications you are using. This is very important especially if you take blood thinners like Warfarin, Plavix, and pain medications like aspirin, ibuprofen, naproxen. The doctor may ask you to stop taking them a few days before surgery because of the risk of bleeding.
• Fasting before the procedure. The doctor will ask you not to eat or drink after midnight. In the morning you may only take your medications with a little water.
• Limitation of activity. The patient may not be able to work for a few weeks. Ask the doctor how long you need to be able.

What happens during and after the procedure

The TURP (Transurethral Resection of the Prostate) procedure lasts about 30-60 minutes. Anesthesia is performed in two ways; either spinal anesthesia, which is local anesthesia in the lower back, through which the patient feels no pain and is awake during the entire procedure, or general anesthesia in which he is asleep.

At the same time, an antibiotic dose is applied to prevent infection.

During the procedure

The resectoscope, which is a combined surgical instrument with a visual system, is inserted from the tip of the penis through the urethra into the prostate area. The resectoscope has a light at the tip, several valves to control the irrigation solution, and an electric wire in the form of a loop to cut the prostate tissues and to stop bleeding.

The prostate is cut into small pieces which are initially pushed into the bladder and at the end of the intervention are taken out.

Although BPH is not cancer, the removed parts of the prostate are sent for biopsy to exclude any hidden cancer cells or other pathology.

After the procedure

After surgery, the patient should stay in the hospital for 1-3 days.

• The patient leaves the operating room with a catheter. The catheter is inserted from the tip of the penis and pushed into the bladder to drain the urine collected in a bag attached to the catheter. The catheter is left in place for 4-7 days until the patient can urinate on their own. In some cases, it is left longer especially in relatively large prostates. In some cases, urine may leak alongside the catheter, but this is normal because the bladder may release more urine than the catheter's capacity can handle.
• Urination may be painful. Generally, this improves after 1-4 weeks. The patient may initially have frequent urination and the feeling of urgency to urinate.
• There may be blood during urination. This is common immediately after the intervention. If clotted blood or a large amount of blood is seen, the doctor should be contacted.

Some tips that help for fast healing after the procedure

• Drink plenty of water to flush the bladder.
• Avoid straining the abdomen during bowel movements. Use fiber-rich foods and avoid those that cause constipation. If there is constipation, a laxative should be used.
• Blood thinners should not be used until allowed by the doctor.
• Heavy physical activities such as lifting weights should not be done for 4-6 weeks.
• Sex should not be had for 4-6 weeks.
• Should not drive until recommended by the doctor. Generally, driving is possible after the catheter is removed and when pain medications are stopped.

Results

Most patients experience significant relief of symptoms. Since parts of the prostate remain after the procedure, it is possible for BPH symptoms to reappear. However, most patients can be symptom-free from 7 to 15 years.

After TURP, it is important to undergo a digital rectal examination once a year to check the prostate for prostate cancer. If symptoms worsen, they should be treated to relieve them especially in those who have undergone TURP many years ago.