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Transurethral Resection of the Prostate (TURP)
The classic surgical way of treating prostate enlargement or BPH is to do a transurethral resection of the prostate, or TURP. Using a special telescopic electric knife which allows an excellent view of the prostate channel, we are able to remove the part of the prostate which is blocking the channel. The entire prostate is NOT removed in this operation, but only that portion which is obstructing the channel. The procedure requires spinal or general anesthesia and takes approximately 45-60 minutes to complete. In preparation for the Operation you may need blood tests, cardiograms, and other tests done prior to your surgical date, or on the morning of admission.
It is very important that you refrain from eating or drinking anything for at least eight hours prior to your scheduled operation time. In most circumstances this means nothing should pass your lips after midnight the night before your surgical procedure. Aspirin, ibuprofen, coumadin, and other blood thinners are to be avoided for ten days prior and for several days after surgery as well (after your urine clears of any bleeding). If you are on coumadin please notify us why and who monitors your coumadin dosing.
Foley Catheter after TURP This tube or 'catheter' will be placed through your penis, through the prostate channel and into your bladder. It is held in position by a small balloon at the end of the tube which is inflated after it is placed. This tube or 'catheter' that is in the bladder is very important for your early post-operative recovery. It essentially puts the bladder and prostate at rest, and if there is any bleeding it allows the blood to come out immediately rather than staying in the bladder and prostate to form clots. Occasionally clots may form and the tube may stop draining. A special syringe with water can be used to hand irrigate the catheter to free it of clots. Hand irrigation might be somewhat uncomfortable, but necessary to clear any plugging of the channel and allow the urine to flow.
Post-operative Care In most instances you will be able to eat a regular meal on the evening of surgery. You may go home the evening of surgery or stay overnight in the hospital, depending on the circumstances of your case. You should refrain from any unnecessary activity while the catheter is in place. Your usual medications may be restarted immediately after the surgery (except aspirin, ibuprofen, coumadin, and other blood thinners).
Post Operative Expectations You may continue to have voiding symptoms for a variable amount of time, and this includes getting up at night, frequency, some hesitancy and blood in the urine. You may also have irritation and burning with urination for several weeks after the surgery as the urethral lining heals. It may take as long as six to eight weeks to get a better idea of how successful the operation might be, depending on how much damage was done to the bladder wall by the obstruction of the prostate before the operation.
After discharge to home from the hospital because of the raw surface around your prostate and the irritating effects of urine, you may expect frequency of urination and/or urgency (a stronger desire to urinate) and perhaps even more getting up at night. This will usually resolve or improve slowly over the healing period. You may see some blood in your urine over the first six weeks. Do not be alarmed, even if the urine was clear for a while. Refrain from strenuous activity and push fluids until clearing occurs.
Comparison of Three Methods of BPH Treatment:
Transurethral Microwave Therapy (TUMT) results are roughly equivalent to combination medical therapy. KTP Laser and TUMT can be performed without taking a patient off anticoagulant therapy, such as a coumadin.
Retrograde ejaculation (the ejaculate goes into the bladder rather than out the penis) or decreased ejaculate are common after TURP. In roughly 40-75% of cases there will be no ejaculate fluid with ejaculation or there may be retrograde ejaculation. With retrograde ejaculation the orgasm occurs as usual but with ejaculation the sperm will enter the bladder but not exit through the urethra.
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