Following are the indications for surgical treatment

The prostate gland sits around your urethra (waterpipe) as it leaves the bladder and, when it enlarges, it may block the flow of urine.

Transurethral resection of Prostate (TURP) is the gold standard for surgical treatment and involves telescopic removal of the obstructing, central part of the prostate with diathermy (electric current), creating a wide channel to allow urine to flow more easily. A temporary bladder catheter at the end of the operation and bladder is washed out using saline usually for the first 24 hours after the operation.

            

• Permanent catheterisation – especially in patients with refractory urinary retention who are not considered suitable for surgery

• Other surgical procedures – including holmium laser enucleation of the prostate (HoLEP), green-light laser prostatectomy or “open” surgery. 

Your urologist (or a member of their team) will briefly review your history and medications, and will discuss the surgery again with you to confirm your consent.

An anaesthetist will see you to discuss the options of a general anaesthetic or spinal anaesthetic. The anaesthetist will also discuss pain relief after the procedure with you.

You will be provided with a pair of TED stockings to wear, and heparin injection to thin your blood. These help to prevent blood clots from developing and passing into your lungs. Your medical team will decide whether you need to continue these after you go home.

• we normally use a general anaesthetic (where you are asleep) or spinal anaesthetic (where you are unable to feel anything from your waist down)

• we usually give you an injection of antibiotics before the procedure, after you have been checked for any allergies

• we put a telescope into your bladder through the urethra (water pipe) and remove the central part of the prostate a piece at a time using a diathermy loop (pictured).

• the prostate is removed in small pieces, evacuated from the bladder by suction, and the chippings are sent for pathology analysis

• once the prostate has been removed, we carefully coagulate (burn) any bleeding points in the cavity left by the surgery

• we put a catheter into your bladder at the end of the procedure             

 • we normally use bladder irrigation in and out of the catheter, to flush through any clots or bleeding

• on average, the procedure takes 45 to 60 minutes to complete

• you should expect to be in hospital for one to three nights

We normally remove your bladder catheter after one to three days. You may find it painful to pass urine at first and it may come more frequently than normal. Tablets or injections can help with this, and it usually improves within a few days.

Your urine may turn bloody for 24 to 48 hours after removal of your catheter and some patients cannot pass urine at this stage. If this happens, we put another catheter in, before removing it again 48 hours later.

The possible after-effects are shown below. Some are self-limiting or reversible, but others are not. The impact of these after-effects can vary a lot from patient to patient; you should ask your surgeon’s advice about the risks and their impact on you as an individual:

 What can I expect when I get home?

• you will be given advice about your recovery at home

• you will be given a copy of your discharge summary and a copy will also be sent to your GP

• any antibiotics or other tablets you may need will be arranged & dispensed from the hospital pharmacy

• you should drink twice as much fluid as you would normally for the first 24 to 48 hours, to flush your system through and reduce the risk

of infection

• you may return to work when you are comfortable enough and when your GP is satisfied with your progress

• one patient in five (20%) gets some bleeding 10 to 14 days after getting home, due to scabs separating from the cavity of the prostate. If this happens, you should increase your drinking; if it does not settle, you should contact your GP who will prescribe antibiotics for you

• if you have severe bleeding, pass blood clots or have sudden difficulty passing urine, you should contact your GP immediately; this may re- admission as an emergency

Some loss of control is common in the early days, so it is helpful to start pelvic floor exercises as soon as possible; these can improve your control when you get home. Click the link for further information on these exercises, or contact your urology Specialist Nurse. The symptoms of an overactive bladder (frequent & urgent urination) can take up to three months to settle, whereas the flow of urine is usually improved immediately.

It will be 14 to 21 days before the final biopsy results on the tissue removed are available. All biopsies are discussed in detail at a multi-disciplinary meeting before any further treatment decisions are made. You and your GP will be informed of the results after this discussion.

Most patients need two to three weeks at home before they feel ready for work. We recommend three to four weeks’ rest before you go back to work, especially if your job is physically demanding; you should avoid any heavy lifting during the recovery period.

We thank the British Association of Urological Surgeons for allowing to use the information for patients. For further information please click the link to BAUS Information Leaflet.