Trans-urethral resection of the prostate (TURP)

Welcome

At Mater Health Services we understand that having an operation can be a very stressful experience. This booklet aims to alleviate some of your concerns in keeping with our Mission to offer compassionate, quality care that promotes dignity whilst responding to patients’ needs. It explains briefly what to expect before you come to hospital, the events that may occur during your visit and the things to expect when you are discharged from the hospital.

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

If you have any questions about your treatment please ask your doctor or nurse. Our pastoral care team offers a caring support network to all patients. The dedicated members of this team will visit you during your stay and are available at your request to discuss any anxieties or problems that you may have.

Trans Urethral Resection of Prostate (TURP)

Please understand the following information should supplement what your doctor has already discussed with you regarding your operation and is simply providing you with a summary of information.

Transurethral resection of the prostate is the operation carried out primarily to relieve obstruction of urine passing from the bladder through the urethra. This operation is also known as a "Rebore".

In most cases a spinal anaesthetic is given. In some cases a general anaesthetic is given. Your anaesthetist will discuss these options with you.

The operation is performed by 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 placed and usually kept in place from between one to three days after surgery. While the catheter is in place irrigating fluid flows 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 clots.

Potential complications of surgery

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

Risks

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 three 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.

NB: seek medical advice if you are passing heavy blood or clots.

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 a TURP. This means the semen goes into the bladder instead of down the urethra during ejaculation. The semen is passed out when you empty your bladder.

Irritative urinary symptoms: following surgery it is usual to have frequency of urination and urgency. Initially you might even find it difficult to reach the toilet in time. It is often thought that drinking less will resolve the frequency and urgency symptoms however it can actually add to the problem. It is therefore important to maintain the recommended fluid intake amount while you are experiencing these symptoms. Over the counter remedies such as Ural and Panadol may assist in relieving these symptoms.

Incontinence: in less than 0.5 per cent of cases incontinence can occur.

Penile erection: approximately one to two per cent of men who are sexually active before surgery will lose their ability to have a penile erection—however there are effective treatments available if this does occur.

After your operation

• You will stay in the recovery room within the theatre suite after the operation while you waken from anaesthetic. You will be transferred on your bed to your room in the ward.
• 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.
• 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.

The following exercises help prevent complications suchas chest infections and blood clots in your legs. You should do these every hour that you are awake while resting in bed.

Breathing 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.

• You will have a urinary catheter in place draining blood stained urine. Irrigation fluid will be attached and is used to flush the bladder of any blood or clots.
  • Blood in the urine is normal after this type of operation. Irrigation fluid and increased oral fluids help flush the bladder and clear away any clots or blood.
  • While the catheter is in place you may experience bladder spasms or contractions. This can be caused simply by the bladder reacting to the catheter being in place or because the bladder is not emptying properly. The spasms make you feel like you need to pass urine and may cause leakage around the catheter. These spasms are unpleasant but do not cause long-term damage. NB: If your bladder feels full please notify your nurse. They will be able to assist you.
• Your nurse will take frequent observations of your vital signs (eg pulse and blood pressure), the return of your sensation to your legs, will keep checking the colour of your urine and that the catheter is draining freely.
• Your nurse will assist you to have a wash sometime after you return to the ward.
• You will have IV fluids to help re-hydrate you.
• It is best to introduce food and fluids slowly following your surgery as the anaesthetic can cause you to feel nauseated. Begin with sips of water and ice then progress gradually to a normal diet, as tolerated. When you are able to tolerate fluids it is important for you to drink plenty to help flush any blood out of the bladder.
• Your IV is usually removed the day after your operation.
• Please tell your nurse if you have pain or nausea. There are treatments that can be given to relieve this.
• It is essential you do not become constipated or strain when opening your bowels. This may cause bleeding. Constipation can be avoided by fluids, diet and aperients.

In preparation for your discharge

• Your catheter is usually removed day one or day two after surgery.
• After your catheter has been removed your nurse will monitor your urination by
• Measuring your urine each time you pass it (you will be needing to use a bottle).
• Performing bladder scans randomly to check how your bladder is emptying.
• Once your catheter has been removed your bladder needs time to readjust to ‘working properly’. Drinking large volumes of fluid at one time can cause the bladder to overfill. It is recommended that you keep maintaining the two to three litres of fluid however it is important to divide the amount over the entire day
• Your medical team will visit you.
• You will be encouraged to mobilise depending on the amount of blood in your urine.
• You will be encouraged to shower and assistance will be provided if you are in need of it.
• You will be eating normally.
• You will be given your medications and advised when to recommence those that have been stopped.
• Your IV drip will be removed before you go home.

If you are going home with a catheter you will

• receive education and written instruction on the care of your catheter
• spare catheter bags
• instructions for when and where you will be having your catheter removed.

Discharge advice following TURP

Even though you do not have an external visible scar it is important to remember you do have an open wound that is still healing therefore the following discharge advice is very important to understand and follow:

What to expect

• Initially you may experience burning during urination, a loss of some control of urination or need to urinate frequently. These symptoms are normal and will eventually settle down.
• Approximately nine to fourteen 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 the emergency centre.

What to avoid

• strenuous activity and heavy lifting for six to eight weeks
• strenuous activities, including heavy lifting (over 4.5 kg), long walks, sports or sexual intercourse until healed or as directed by physician
• straining during bowel movements.

Avoid constipation by:

• eating a diet high in fibre
• drinking two to three litres of fluid per day
• not taking codeine-based analgesia.

What to do

• Rest for the first two days after you are discharged from hospital. Bleeding is most likely to occur between days 9–14 post-op due to the scab on your wound coming away. Avoid any unwise activity at this time.
• Mobilise around the house and yard for the first two weeks, then begin going for short walks of five to ten minutes.
• Your activity level should gradually increase and be guided by the presence of blood in your urine.

Contacts

Please contact either your General Practitioner (GP); Mater Hospital Brisbane Emergency Department or your closest Emergency Department if you experience any of the following after discharge:

• the amount of blood in your urine increases
• you cannot pass urine
• you develop a fever
• you develop confusion, agitation changes in mental status or you experience visual disturbances (TUR syndromes)
• you develop nausea and vomiting (TUR syndrome).

Mater Hospital Brisbane

Raymond Terrace

South Brisbane Q 4101

Acknowledgements

Staff of Mater Hospital Brisbane, Raymond Terrace, South Brisbane Q 4101

© 2010 Mater Misericordiae Ltd. ACN 096 708 922.

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