A Trans-Urethral Resection of the Prostate (TURP) is a surgical procedure to improve symptoms of benign prostatic hyperplasia (BPH).
BPH is caused by an enlargement of the prostate gland. The prostate gland sits at the base of your bladder and surrounds your urethra (the tube that urine passes through when you urinate). When the prostate gland is enlarged it may narrow the urethra, which can make passing urine difficult. Some symptoms of this include weak stream when passing urine, poor flow of urine, frequency of needing to pass urine, urgency, hesitancy, waking through the night to pass urine and having urine dribble at the end of passing urine.
Why is a TURP performed?
The procedure is carried out to treat men when obstructive urinary symptoms become severe and cannot be treated adequately with medications or when medication therapy is not appropriate.
What does a TURP involve?
Your urologist will perform the procedure under a spinal or general anaesthetic. A telescopic camera (cystoscope) along with a thin flexible fibre is inserted into the penis up your urethra to your prostate. A special electrode is used to cut away the prostate tissue to create an open channel. At the end of the procedure, a catheter (a flexible hollow tube used to drain urine from the bladder) is placed and usually kept in place for one to two days after surgery.
While the catheter is in place, you will have irrigating fluid flowing in and out of the bladder through the catheter. The purpose of this fluid is to keep the operated area and the bladder clean and free of blood clots.
What are the advantages of TURP?
A TURP may be recommended over other prostate procedures if you have a smaller prostate.
What are the possible complications of TURP?
Bleeding
The risk of significant bleeding is low post TURP but does occur occasionally. It is common to see blood in your urine after your surgery and will be monitored by the ward staff. This should settle within six weeks after your surgery.
Dysuria (painful passing of urine)
This is common and should settle over time. If this persists longer than six to eight weeks further review may be required.
Retrograde ejaculation (dry orgasm)
This occurs in most men after TURP at the time of sexual climax. This is due to the surgery, which causes your semen to travel backwards to the bladder rather than exiting through the penis. This is not harmful and generally doesn’t affect sexual pleasure, however it is not reversible. Please ask your urologist if you need further information.
Urine infection
The risk of infection is low post TURP but occurs occasionally (less than 10 per cent of patients). You may require further treatment if this occurs and you should notify your GP or present to your local emergency department in this event.
Erectile dysfunction
Changes to erectile function after this procedure are uncommon but may affect approximately one per cent of patients.
Urethral stricture (scar tissues along urethra)
This is rare but there is a small risk of this occurring whenever a scope is inserted into your bladder.
Incontinence (urine leakage)
Some patients will experience small amounts of urine leakage within the first few weeks of recovery but this should resolve over time. Permanent incontinence is extremely rare.
Bladder or ureteric injury (water-pipe injury pelvic)
This is rare but there is a small risk of this occurring whenever a scope is inserted into your bladder.
What preparation is needed before surgery?
- You will be booked for a pre-admission appointment (either face-to-face or via phone) prior to your procedure.
- Please discuss any medications with your urologist or pre-admission nurse. Some medications may need to be stopped prior to your procedure including blood thinners, diabetic medication and herbal supplements
- Please attend a urine test and all recommended blood tests or investigations 10 – 14 days prior to your procedure to avoid cancellation.
- Please confirm your booking five days prior to your procedure via phone: 07 3136 8444 (8.30am to 4pm, Monday to Friday).
What do I need to do on the day of my surgery?
- Shower or bath at home and put on clean clothes.
- Fast (stop eating and drinking) as per the instructions provided by your doctor or nurse.
- Continue to take all medications as prescribed by your doctor unless advised of any changes.
- Bring the following to your hospital appointment:
- Medicare Card and pension cards
- Completed registration form(s)
- All current medications.
- Please do not bring any valuables or wear any jewellery when you come to hospital.
- You will receive a text message with your arrival time. It is important to note that your arrival time is not your procedure time. Your arrival time allows time for admission and appropriate preparation prior to your procedure.
What should I expect after my procedure, while I am in hospital?
You will stay overnight in hospital with the nursing team performing regular checks of your urine and vital signs (e.g. temperature, blood pressure and heart rate). You will have a catheter (tube into your penis) overnight to drain urine. You will have irrigations (fluid being flushed into your catheter) to ensure blood/clots are flushed out of your bladder. You will have some blood in your urine, this is normal.
What should I expect after my procedure, while I am in hospital?
It is important that you remain on bedrest following your surgery until the next morning. Reducing your activity allows your body to recover from the anaesthetic and reduces the possibility of bleeding.
You will be reviewed by your medical team to determine when your catheter will be removed. This is normally on day one or day two after surgery and will depend on the amount of blood you have in your urine.
When your catheter is removed, we need to ensure that you do not have too much urine left in your bladder. This is checked by having a trial of void. Nursing staff will ask you to pass urine into a container and then assess how well you empty your bladder with a bladder scanner. A bladder scan is an ultrasound which shows the nurse how much urine remains in your bladder after you have passed urine. This will be performed several times.
If you are unable to pass urine or you are utimesnable to empty well enough, a catheter may need to be replaced and you could be discharged with a catheter. This is uncommon but if this occurs your urology team will discuss a follow up plan to remove your catheter. Normally, you will be booked to re-attempt to remove your catheter in one to two weeks post your surgery. You will be given education on how to look after the catheter at home.
What can I expect when I go home?
Initially, you may experience burning during urination, urinary leakage or need to urinate frequently. These symptoms are normal and should settle down over several weeks to months. You may have some blood-stained urine for the first six weeks. Approximately nine to 14 days after your procedure the scab, which forms on the healing prostate surface, will begin to peel away. You may notice some tissue and fresh blood in your urine, which is normal.
For the first week after your procedure, you should rest with some gentle mobilisation. After one week, you should be able to perform normal activities that are not strenuous. This includes short walks and light housework. Your activity level should gradually increase and be guided by the amount of blood in your urine. Exercise can generally be commenced after six weeks. If you are working, you should discuss with your team to determine when you should to return to work.
You will have a follow-up appointment scheduled at approximately eight weeks to check on your urinary symptoms post your procedure.
What can I do to help my recovery?
- Avoid strenuous activity for up to six weeks after your procedure to avoid increase bleeding. This includes activities such as mowing the lawn, heavy lifting (over 4.5kg) and sexual activity.
- Maintain good fluid intake:
- Drink two to three litres of fluid per day with the majority of this being water.
- Avoid caffeinated and carbonated drinks as these can make you go to the toilet more often and urgently (rushing to the toilet).
- Alcohol should be avoided for the first 48 hours due to recent anaesthetic. It is also recommended that you avoid or reduce alcohol consumption in the first few weeks as this makes you pass more urine, which will make your urinary symptoms worse.
- Performing pelvic floor exercises can help improve urine leakage and you can start these two weeks after your procedure. For guidance on this you can refer to the Continence Foundation of Australia website.
- You will receive some further information on pelvic floor exercises prior to discharge. • You may find it useful to wear an incontinence pad in your underwear for the first few days to weeks if you are having some leakage of urine.
- Avoid constipation by maintaining a high fibre diet, good water intake and gentle physical activity.
- To assist with your dysuria (burning during urination) you may find taking Ural can assist with reducing the discomfort. This is a powder that is added to water and works by reducing the acidity of your urine. This can be purchased from your local pharmacy.
Please contact either your General Practitioner (GP) or your local emergency department, if you experience any of the following after your procedure: Symptoms of a urine infection including:
- Worsening pain or discomfort on urination o Fever, chills, shaking, increasing drowsiness, or generally feeling unwell.
- Smelly or cloudy urine. • Heavily blood-stained urine or clots that is not settling after increasing water intake and minimising strenuous activity.
- Difficulty passing urine or inability to pass urine