Prostate Surgery - alternatives, side effects and complications

This factsheet is for men who are having or thinking of having a type of prostate surgery called transurethral resection of the prostate (TURP). Your care may differ from what is described here because it is adapted to meet your individual needs, so it's important to follow your doctor's advice.

* Why have TURP?
* What are the alternatives to TURP?
* The operation
* What to expect afterwards
* After you return home
* Deciding to have a TURP
* Side-effects
* Complications
* Further information
* Sources
* Related Bupa factsheets

Why have TURP?
Your prostate tends to grow as you get older. In some men, the prostate can get large enough to put pressure on the urethra, causing problems such as difficulty urinating, incomplete emptying of the bladder or dribbling of urine. This is known as benign prostatic obstruction (BPO). It isn't cancer and there is no evidence that it leads to cancer. TURP is an operation to remove some of the enlarged prostate gland so that urine can flow more freely.
What are the alternatives to TURP?
Not all men who have BPO need to have a TURP. There are a number of other options.
Medicines. These include alpha-blockers, such as doxazosin. They improve the flow of urine and/or shrink the prostate by relaxing smooth muscle fibres.
Heat therapy. This uses microwaves, lasers or an electric current to destroy excess prostate tissue. One example is TUVP (transurethral electrovaporisation of the prostate).
Greenlight laser photoselective vaporisation of the prostate (PVP). This is a new method of treating BPO in which a laser emitting green light is used to vaporise a passage through the prostate, so reducing it in size.
A stent. This is a short tube that is inserted into the urethra to help improve the flow of urine. Stents can become blocked over time, so they are only used for men who aren't suited to surgery or drug treatment. They are rarely used.
Herbal remedies. Some men find saw palmetto extract helpful. However, there is conflicting evidence over its effectiveness.
No treatment. If the symptoms are not too troublesome, some men choose not to have any treatment. The symptoms of BPO do not always get worse over time and may get slightly better.
The operation
A TURP is usually performed under general anaesthetia so that you are asleep and feel no pain throughout the procedure. However, the operation can be done under spinal anaesthesia, so that you are awake but feel no pain. Typically, no food and drink is allowed for about six hours before a general anaesthetic. However, some anaesthetists allow a few sips of water until two hours beforehand.
Once the anaesthetic has taken effect, the surgeon inserts a thin, tube-like telescope (a resectoscope) through your penis and into your urethra. An attachment that carries an electric current is used to "chip away" at the prostate and to stop any bleeding.
During the operation, your bladder is flushed with a sterile solution to remove the chippings of prostate tissue. A catheter (a thin flexible tube) is then inserted through your urethra and into your bladder.
The operation itself takes about an hour, but you'll need to stay in hospital for about four days in total.
What to expect afterwards
As the anaesthetic wears off, you may feel some pain and your anaesthetist may prescribe painkillers. You may have a drip in your arm to prevent dehydration - this will be removed once you are drinking enough fluid.
The catheter is left in your bladder after the operation. One or more bags, usually hanging above the bed, store liquid that runs slowly into your bladder through the catheter. This is to help flush out any blood clots in your bladder.
With the catheter in place you may feel the urge to pass urine, but this sensation should go within a few minutes. Tell your doctor or nurse if your bladder starts feeling full - sometimes a small blood clot can block the catheter.
The catheter will be removed when the urine begins to run clear; this is usually within two to three days. When you first start to urinate, you may feel a stinging sensation and your urine may be cloudy. To start with, you may have a constant urge to urinate and it may be difficult to control the flow. You may also have leaks or dribbles of urine, but this usually goes away within 24 hours.
After you return home
If you need them, you can take further painkillers as advised by the hospital. You should aim to drink at least two litres of fluid a day to flush out your bladder and help you to recover. It's common to have occasional blood clots (red-brown or purple flecks) in the urine. For a few weeks after the operation, you may also find that you leak urine when you cough or strain. To help with this, you can wear an absorbent liner inside your underpants.
You should contact your hospital or a GP immediately if you have:

* heavy bleeding
* a high temperature
* increasing pain
* inability to urinate

It usually takes four to six weeks to recover fully from a TURP. After this, you can resume your normal activities, including sex. You shouldn't do any strenuous activity for about six weeks after the operation.
Deciding to have a TURP
TURP is generally a safe operation. However, in order to give informed consent, anyone deciding whether or not to have a TURP needs to be aware of the possible side-effects and the risk of complications.
Side-effects
Side-effects are the unwanted but usually mild and temporary effects of a successful procedure. Examples include feeling sick as a result of the general anaesthetic and some discomfort from the catheter. In addition to these, some specific side-effects can be expected as a result of this operation, including the following.

* Your urine will contain blood for several days - this will gradually clear.
* You may feel an urgent need to pass urine, and a burning sensation when you do - this will gradually improve.
* You may experience mild incontinence (urine leakage) - talk to your doctor if this happens, but it nearly always clears up.
* Most men find that a lasting side-effect of a TURP is dry orgasm (retrograde ejaculation), where very little or no semen is ejaculated. This happens because the surgery makes it possible for semen to travel back up into the bladder rather than out through the penis at the time of orgasm. This shouldn't interfere with sex and, after recovery from the operation, most men return to the same level of sexual activity as before the treatment. Retrograde ejaculation doesn't mean that you can't father children, but it may reduce your fertility.

Complications
Complications are unexpected problems that can occur during or after the operation. Most people are not affected. The complications of this operation include excessive bleeding, a urinary tract infection, pain when urinating or an unexpected reaction to the anaesthetic. It is also possible for too much water to be absorbed from the fluid used to flush the bladder during the operation. This can temporarily upset the balance of salts in the blood, which can be harmful, particularly for people who already have heart or kidney problems. The condition is sometimes known as TURP syndrome.
Rarely, it's possible to develop a blood clot (known as deep vein thrombosis or DVT) in the veins of the leg. This clot can break off and travel to the lungs to cause a blockage. In the majority of cases, this is treatable, but it can be a dangerous condition. People having surgery are routinely given medicines or compression stockings to wear during the operation to help prevent a DVT.
Although most men will worry about how TURP will affect their sex life, research indicates that it doesn't increase the risk of erectile dysfunction.
You may need to have the procedure again if your prostate grows back or if too little was removed during the first operation.
Further information

* Bupa Health Survey

Results from our survey of hundreds of people who have had a TURP

www.bupa.co.uk/healthsurveys
* Prostate Help Association (PHA)

www.pha.u-net.com

Sources

* Benign hyperplasia > management issues. Prodigy Guidance.

http://cks.library.nhs.uk/prostate_benign_hyperplasia/extended_information/management_issues

accessed 11 June 2007
* Turp. Clinical evidence.

http://www.clinicalevidence.com/ceweb/conditions/msh/1801/1801_I3.jsp

accessed 11 June 2007
* BPH > Treatment. Prostate research campaign UK.

http://www.prostate-research.org.uk/bph/bphsurgery.htm

accessed 8 June 2007
* A patient's guide to TURP - your prostate operation. Prostate Cancer Centre.

http://www.prostatecancercentre.co.uk

accessed 11 June 2007
* Transurethral prostatectomy for benign prostatic hyperplasia. Bandolier.

http://www.jr2.ox.ac.uk/bandolier/band15/b15-6.html

accessed 11 June 2007
* Drugs for urinary retention. British National Formulary 52: 425, 2006
* Transurethral microwave therapy for BPH. Bandolier.

http://www.jr2.ox.ac.uk/bandolier/booth/Mens/TUMT.html

accessed 11 June 2007
* IPG 120 Potassium-titanyl-phosphate (KTP) laser vaporisation of the prostate for benign prostatic obstruction - information for people considering the procedure, and for the public. NICE.

http://www.nice.org.uk/IPG120publicinfo
* Transurethral electrovaporisation of the prostate. NICE Guidance 2003.

http://guidance.nice.org.uk/IPG14

accessed 11 June 2007
* Saw palmetto and prostatic hypertrophy. Bandolier.

http://www.jr2.ox.ac.uk/bandolier/band73/b73-2.html

accessed 11 June 2007
* Bent, S., Kane, C., Shinohara, K. et al. (2006) Saw palmetto for benign prostatic hyperplasia. New England Journal of Medicine 354(6), 557-566
* Benign hyperplasia > management issues. Prodigy Guidance.
http://cks.library.nhs.uk/prostate_benign_hyperplasia/extended_information/management_issues

accessed 11 June 2007

Published by Bupa's health information team, March 2007.
extract from: hcd2.bupa.co.uk