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Trans-urethral resection of prostate

Mater Private Hospital Brisbane

The largest of Mater Health Services’ private facilities, Mater Private Hospital Brisbane is a flagship for the level of care and facilities our organisation strives to provide.The tertiary, acute facility is built on a foundation of clinical excellence and a commitment to safe, compassionate care, that is:

  • quality focused
  • technologically advanced
  • customised to patients’ needs and lifestyle.

Mater Private Hospital Brisbane is an outstanding health care provider with a total of 323 patient beds, ten operating theatres, a 24-hour private emergency service, preadmission clinic, Cardiovascular Unit, Intensive Care and Coronary Care Units, Breast Cancer Centre and Day Procedure Unit.

All rooms and facilities are designed to offer comfort and privacy, complete with a range of modern, air-conditioned accommodation.

While in hospital, patients also have access to allied health (e.g. dietitians, physiotherapists), pharmacy, hairdressing and chaplaincy services.

For more information about Mater Private Hospital Brisbane, please phone 07 3163 1111.

Visiting hours

8 am to 8 pm (patient rest period 1.30 pm to 3.30 pm)

Our Mission

In the spirit of the Sisters of Mercy, Mater Health Services offers compassionate service to the sick and needy, promotes an holistic approach to health care in response to changing community needs and fosters high standards in health-related education and research.

Following the example of Christ the Healer, we commit ourselves to offering these services to all without discrimination.

Our Values

Mercy: the spirit of responding to one another

Dignity: the spirit of humanity, respecting the worth of each person

Care: the spirit of compassion

Commitment: the spirit of integrity

Quality: the spirit of professionalism

At Mater Private Hospital Brisbane, we acknowledge that having an operation can be a very stressful experience. In keeping with our Mission to offer compassionate, quality care that promotes dignity whilst responding to patients’ needs, this booklet aims to alleviate some of your concerns. It explains the general day to day events that may occur during your visit and the things to expect when you are discharged from hospital.

It is, however, only a guideline as each person may require differing treatments.

If you have any questions about your treatment please speak to your doctor or nurse.

Our urology practice nurse is available to provide support to you during your hospitalisation and following your discharge. The nurse can be contacted Monday to Friday from 7am to 3 pm on 07 3163 1119 or 0434 185 271.

Our Pastoral Care team also offers a caring support network to all patients. The dedicated members of this team are available at your request.

We expect that you will stay in hospital for one to two nights, depending on the procedure performed, or until you have achieved the following:

  • you are able to pass urine after the catheter has been removed or if you are discharged with the catheter in place, you are confident with managing the catheter at home
  • your pain will be controlled with oral analgesia
  • your temperature, pulse, and blood pressure are to be within normal limits
  • you will be tolerating your normal fluids and diet
  • you will be independently mobile, attending to your daily needs.

Benign prostatic hyperplasia (BPH)

BHP is a non-cancerous enlargement of the prostate which can cause partial or complete obstruction of the urethra and restrict the normal flow of urine.

This obstruction can be relieved by either of the following procedures below. Your doctor will discuss with you which procedure best suits your condition.

prostate

Transurethral resection of the prostate

Transurethral resection of the prostate (TURP) is an operation carried out primarily to relieve obstruction of urine passing from the bladder through the urethra. Your surgery will be performed under either a spinal or general anaesthetic. Your anaesthetist will discuss these options with you.

The operation involves passing a telescopic instrument in through the penis along the urethra and into the area where the prostate gland is obstructing. A special electrode is used to cut away the prostate tissue. At the end of the procedure, a catheter is inserted and usually kept in place for one to three days after surgery.

While the catheter is in place, irrigating fluid drains into the bladder and out again through the catheter into the bag. The purpose of this fluid is to keep the operated area and the bladder clean and free of clots.

Laser prostatectomy

This procedure involves passing a small fibre into the urethra through a telescopic instrument. The fibre delivers high power laser energy which quickly heats up and vaporises the prostate tissue. At the end of the procedure a catheter may be inserted to allow urine to drain from your bladder. Further information about this procedure can be found in the GreenLightTM Laser Therapy Patient Information Booklet provided by your doctor or nurse.

Potential complications of surgery

While the transurethral resection of the prostate offers high success rates, like any other surgery there are still risks that need to be considered.

Bleeding

The risk of having significant bleeding is very small and it is very uncommon to need a blood transfusion. It is not uncommon though, to have blood in your urine for up to a couple of weeks after the operation and if you do see blood you should:

  • increase your oral fluid intake to at least two to two and a half litres of fluid per day (unless you have medical reason not to do so) reducing fluids when your urine clears
  • reduce your mobilisation and increase your rest time.

Infection

There is a small risk of developing an infection in the urine. This risk is, however, minimised by routine administration of antibiotics at the time of surgery.

Retrograde ejaculation

Most men will experience retrograde ejaculation following surgery. This means the semen will pass backwards into the bladder instead of forward through the urethra resulting in a ‘dry ejaculation’. The semen is passed out when you empty your bladder.

Irritative urinary symptoms

Following surgery it is usual to experience irritation of the urinary tract— frequency of urination and urgency. Initially, you might even find it difficult to reach the toilet in time, however, this is normal following this type of surgery.

Preadmission clinic

Mater Private Hospital Brisbane provides a preadmission service. You will receive this service in any of the following ways:

  • from the specialty clinic to the preadmission clinic
  • at the preadmission clinic
  • via a phone call.

The preadmission service gathers information, initiates investigations to prepare you for your surgery, provides information regarding your specific operation and identifies your discharge needs.

Day of admission/surgery

Before coming to hospital please ensure that you have:

  • had nothing to eat or drink as per the instructions given to you by the preadmission clinic or your doctor
  • showered and dressed in clean clothes. No skin products are to be used following your shower (e.g. deodorant, perfume, body lotion, powder, make up)
  • left your valuables at home. You may wear your wedding band only
  • brought the following with you:
    • your X-rays
    • your operation consent form
    • your medications in their labelled containers or packets.

On your arrival to the hospital please report to the reception desk on level 6, Mater Private Hospital Brisbane where you will be directed to the Welcome Lounge/ Day Procedure Unit. Only one relative/visitor is permitted within the clinical areas of the Welcome Lounge.

Our Welcome Lounge staff will:

  • apply an identification band
  • complete your nursing assessment form
  • take your temperature, pulse, blood pressure and weight
  • ask you to change into a theatre gown and paper pants
  • apply anti-embolic stockings. These assist with blood flow through your legs and decrease the risk of blood clot formation while you have decreased mobility
  • take details of any family member who would like to speak to the surgeon after the operation (preferably a mobile phone number)
  • complete your preoperative checklist.

You may walk around as much as you like, but please do not leave the Welcome Lounge.

Your surgeon may visit with you prior to your surgery, either in the Welcome Lounge/Day Unit or in the preoperative holding area. You will be transferred to the operating theatre on a wheelchair or on your bed if you have received a premedication.

Your luggage will be delivered to the ward where it will be stored in a locked room until after you have returned from theatre.

After your surgery

  • Immediately following your surgery you will be transferred to the recovery room where you will be observed closely until you are more awake.
  • It is common to need oxygen which will be given via a face mask.
  • When you have recovered sufficiently from the anaesthetic you will be returned to your room in the postoperative ward. The nurses will take vital signs—your pulse, respiration rate, temperature, blood pressure and will check your urine and catheter.
  • Your doctor will order pain relief and anti-nausea medications for you. Please tell your nurse if you have any pain or nausea, so these symptoms can be managed.
  • Immediately following your surgery, you will be resting in bed. If you have had a spinal anaesthetic you will be feeling a numbness or heaviness in your legs. This is quite normal. The sensation in your legs will gradually return over a couple of hours. The nurses will advise you when it is safe to get out of bed and mobilise as per your doctor’s instructions.
  • You will have a urinary catheter in place and irrigation fluid running which will flush the bladder. Initially your urine may be blood stained. Irrigations will be discontinued on the first day after surgery unless your urine is heavily blood stained or clots are present.
  • You may experience a sensation of a full bladder while the catheter is in. This may be due to a catheter blockage or bladder spasms. Please notify the nurses immediately if this occurs.
  • Following your operation you will be offered ice to suck or water to sip. After a few hours you can begin to drink fluids as you are able and progress to a normal diet as tolerated. Intravenous fluids (a drip) will be administered until you are able to eat and drink. Once you are able to tolerate fluids it is important to drink plenty to help flush your bladder.
  • When you are feeling more awake your nurse will assist you to have a wash and change into a clean gown.
  • It is important that you begin your breathing and leg exercises. These help prevent complications such as chest infections and blood clots in your legs and should be carried out every hour that you are awake and while on bed rest.

circulation exerciseBreathing exercises: take five long and slow deep breaths. Each breath should be deeper than the previous breath. Think about getting the air to the very bottom of your lungs.

Circulation exercises: firmly move your ankles up and down to stretch and contract your calf muscles.

Post-operative days one to two

Elimination/trial of void

  • Your catheter will be removed early in the morning, usually on the first day postoperatively for the laser procedure and the second day postoperatively for the TURP procedure, and a trial of void commenced.
  • It is important to use a urinal each time you pass urine allowing it to be measured. Even if you do not feel the urge to urinate it is recommended that you attempt to do so every two to three hours. Please notify staff immediately after passing urine so that they can scan your bladder to check that you have emptied it sufficiently.
  • Most men are able to pass urine after the removal of the catheter; however there are times when the catheter needs to be re-inserted. The catheter may then be removed the following day but it is more common to be discharged home with the catheter in place. Staff will instruct you on how to care for your catheter at home and when it needs to be removed.
  • During your trial of void it is important to avoid drinking large quantities of fluid over a brief period which can rapidly fill your bladder. It is recommended that you drink slowly and aim for six to eight cups of fluids per day (approximately two litres). You may also have a drink at morning tea/meal times.

Nutrition

  • You will resume a normal diet as tolerated.

Consults

  • Your urologist will visit you.
  • Our urology nurse will also visit.

Mobility

  • You will be encouraged to mobilise according to your doctor’s instructions and depending on the amount of blood in your urine.

Hygiene

  • Nursing staff will assist you if your catheter and bladder irrigations remain in place otherwise you will be encouraged to shower independently.

Medications

  • You will be given your usual medications.
  • Pain relief medications are available if needed.

Discharge planning

  • You will be ready for discharge following a successful trial of void.
  • Your nurse will discuss your discharge advice form with you. This will include details of any follow up appointments you require. A copy will be given to you prior to discharge.

Day of discharge

  • Discharge from hospital will occur when your trial of void has been completed.
  • A discharge summary form will be discussed and provided.
  • Your own medications will be returned to you and any new ones supplied.
  • Your X-rays will be returned to you. Please remember to ask for them.
  • Your postoperative appointment will be discussed.

Discharge advice

  • Initially you may experience some irritation of the urinary tract—urinary frequency or urgency. You may also experience a burning sensation or a loss of some control. These symptoms are common and will settle down over a few weeks.
  • You can expect to see some blood in your urine on and off for up to eight weeks after surgery
  • Approximately nine to 14 days after your surgery 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 at this time which is normal, however if you experience difficulty passing urine you should report to the emergency centre.
  • To prevent bleeding avoid strenuous activities including heavy lifting (more than 4.5 kg), long walks, sports, sexual activity or straining during bowel movements until healed or as directed by your doctor.
  • Include adequate amounts of fibre in your diet to avoid risk of constipation and straining during bowel movements.
  • Your fluid intake should now gradually increase to two to 2.5 L of water per day unless otherwise indicated.
  • Your activity level should gently increase and be guided by the presence of blood in your urine and your doctors instructions.
  • Sexual activity should be avoided for at least three weeks after surgery or until advised by your doctor.

If you experience any of the following, please report them to your doctor:

  • inability to pass urine
  • fever/cold shivers
  • you are feeling unwell
  • excessive tiredness
  • your urine smells strong or unpleasant or appears cloudy
  • you experience increasing or new:
  • urinary leakage
  • burning or pain when passing urine
  • bladder discomfort or spasms
  • blood in your urine
  • pain.

© 2012 Mater Misericordiae Ltd. ACN 096 708 922

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-450028
Last modified 09/8/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 01/4/2014
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