Trans-urethral resection of the prostate is a surgical procedure to treat patients with an enlarged, benign prostate, called Benign Prostate Hyperplasia or BPH. The prostate is a walnut-sized gland located in front of the rectum, at the outlet of the bladder. It contains gland cells that produce seminal fluid, which protects and nourishes sperm cells in semen. TURP is usually reserved to surgically treat men with significant symptoms. This procedure is performed under a general or spinal anaesthetic. Antibiotics prophylactic dose is given during the operation to reduce the risk of infection. A small operating telescope is inserted into the urethra to remove enough prostate tissue to relieve the pressure on the urethra. The prostate tissue is sometimes removed by laser energy that is passed through the resectoscope. At the end of the operation, the surgeon will place a urethra catheter in the patient's bladder. This will allow the patient to pass urine easily and bladder wash out performed with fluid to prevent blood clots.
The operation takes about one hour. The catheter is removed the next day and the patient's voiding measurements and post void residuals are monitored and documented to ensure he is voiding to completion before discharged. If Trial Without Catheter (TWOC) is unsuccessful, the patient is re-catheterised and discharge home on alpha blocker for 1 week before a retrial.
Other treatment alternatives
For most men, an operation is not essential. There are medications available to treat improve symptoms, and these include:
- Alpha blockers-relaxes the smooth muscles of the prostate, and the bladder neck, which helps improve urine flow. Side effects include headaches, fatigue and light-headedness. Commonly used Alpha blockers are Alfuzosin and Tamsulosin
- 2. 5-Alpha reductase inhibitors- block the conversion of the male hormone testosterone into its active form in the prostate (DHT). These drugs reduces the prostate size by 25%. Examples of 5-Alpha reductase inhibitors include: Finasteride and Dutasteride. Side effects include reduced libido, problems with getting an erection and ejaculation
- Complications of anaesthesia
- General complications:
- Pain - can be controlled with pain relief.
- Bleeding - during or after surgery. Blood stained urine or rose haematuria is expected. Advice patient to maintain a good fluid intake to flush out the bladder. Bladder washouts can be performed to wash out blood and blood clots. If with frank haematuria, check haemoglobin level - if Hb >8, the patient will need blood transfusion (risk: less than 1 in 20) and rarely, further surgery.
- Infection - This is treated with antibiotics (risk: 1 in 10). The risk increases if the patient had a catheter inserted before surgery.
- Blood clots in the legs (deep-vein thrombosis - DVT). Encourage the patient to get out of bed soon post-operatively. Can also be prevented wearing TEDs stockings, giving medication or injections.
- Specific complications of this operation:
- Impotence-problems maintaining and sustaining an erection (risk: 1 in 20). This is more common in older men who may already have problems with impotence.
- Retention of urine - (risk 1 in 50) the patient may need re-catheterising again for one to two weeks while at home.
- Incontinence - this may happen a short while after the operation. This may be permanent (risk of permanent incontinence: less than 1 in 50)
- Reduction in fertility, caused by retrograde ejaculation. This is where the fluid produced at ejaculation passes back into the bladder rather than out of the penis (risk: 9 in 10).
- Narrowing of the urethra (stricture) caused by scar tissue forming. The patient may need further surgery (risk: less than 3 in 100).
Recovery period to return to normal activities is 2 weeks.