Urology. Transurethral Prostatectomy (TURP) patientinformation. Rotherham Hospital Your health, your choice, our passion

Transcription

1 Urology Transurethral Prostatectomy (TURP) patientinformation Rotherham Hospital Your health, your choice, our passion

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3 Figure 1 Enlarged Prostate Figure 2 Ureter Seminal Vesicle Kidney Bladder Prostate Gland Male Anatomy Penis Testis Urethra What is a prostate? The Prostate is a gland which is around the neck of the bladder (see figure 1 and figure 2). Why do I need an operation? As men get older the prostate gland enlarges. This causes minor problems such as passing urine more frequently, having a poor stream and getting up to pass water in the night. Sometimes it can cause a total blockage so no urine can be passed if problems haven t been detected earlier. An operation is then necessary to remove part of the prostate gland to allow a free passage of urine. Is there an alternative to surgery? The only alternative to surgery is to continue with the drug therapy and wait and see if your symptoms get better, although this is unlikely. The doctor in charge of your case has considered your situation and feels that surgery is the most appropriate treatment for you at this time. However, you will have the opportunity for your opinion to be considered and if you do not wish the surgery to be carried out, you can discuss this with your doctor. 3

4 What preparations should be made? Although the operation usually takes 45 minutes, pre-operative checks are needed. You will be invited to attend a pre-assessment a few weeks before your admission to hospital, where you may have blood tests, urine tests, x-rays, and ECG s (electrocardiograms), to check that your general health is satisfactory. If not these checks will be made on the day before your surgery. You will stay in hospital between 2 to 4 days on average, though in very elderly patients this may be longer. 4 Pre-Admission Centre Once the doctor has decided that you need to have this operation you will need to have a pre-operative assessment. During your assessment in pre-admission, you will be asked questions about your medical, surgical and social history. You will need to bring a list of your most recent medications with you. If you are deemed fit fo surgery at your assessment, then you will be offered a date for your operation. Once you have agreed and confirmed this date, a letter will be given or sent to you with the instructions regarding your admission for surgery. If anything changes i.e. you get a cold, infection or your GP changes any of your medication, then you must phone the Pre-Admission Centre on any of the following numbers. Urology Booking Cerk Urology Clinical Nurse Practitioner Pre-Admission Department Sister

5 The Operation Almost all prostate operations are carried out transurethrally. This means that a telescopic instrument is inserted into the bladder via the urethra (the tube from the bladder through which urine is passed to the outside) throughout the length of the penis. The surgeon can see the enlarged prostate and uses an electric current (diathermy) to remove the prostate in small pieces. The pieces of prostate are removed through the same instrument at the end of the operation. A general anaesthetic is usually needed, although a spinal or epidural anaesthetic (regional anaesthetic) which deadens the area being operated on may be possible. At the end of the operation, a catheter tube is placed in the bladder coming out from the end of the penis. This drains blood and urine from the bladder and will remain in place for 24 to 48 hours after the operation. It doesn t cause any pain but can be uncomfortable when moving around. The catheter tube is usually removed on the second or third day after the operation. You will remain in hospital for a further 12 to 24 hours to ensure that all is well before going home. At this stage, your urine may still be bloodstained and you may feel you need to pass urine very urgently. Both these are very common and will subside over the next two to six weeks. Throughout your stay in hospital it is important to drink at least 5 to 6 pints of fluids every day to ensure a better flow of urine. 5

6 Are there any complications? TURPs are carried out very frequently and have a low complication rate. A little bleeding and a stronger than usual desire to pass urine are quite common in the first six months after the operation. You may also have some discomfort on passing urine for two to six weeks. The full benefits of the operation may not be felt for about 2 to 3 months. Excessive bleeding sometimes occurs immediately after the operation and can be treated with a blood transfusion. A second operation to stop the bleeding is seldom needed. The bladder may need to be flushed through with fluid to wash out blood clots. Failure to pass urine properly when the catheter is removed may be due to a blood clot or to a remaining piece of prostate. The catheter will then need to be replaced and sometimes a further operation is necessary. Inability to control the flow of urine is very rare after a prostate operation but can happen. This is difficult to treat but not impossible. 6 What about when I get home? You will be able to get back to your normal activities slowly as you feel better. Please continue to drink at least 2 to 3 pints of fluid each day for the first two weeks at home. Don t drive for two weeks and avoid any heavy lifting and strenuous activity such as gardening, carrying heavy shopping bags, golf and bowls etc. for six weeks.

7 What about work? Please ask the ward staff for a sick note before leaving the ward. If your job does not involve any heavy lifting you may go back to work after 2 to 4 weeks if your GP agrees. If your job is demanding and involves a lot of lifting you shouldn t go back to work for 6 weeks. Will a TURP affect my sex life? When you resume sexual activity, you will probably notice that the semen is no longer emitted from the end of the penis. The sensation of orgasm is present but altered, as the semen is ejected backwards into the bladder. Because of this it may not be possible to father children, although the performance of the sexual act should not be altered. The ability to get an erection will very occasionally be affected by a prostate operation. At present urologists are unable to predict which patients will have this problem. If you have any problems getting or sustaining your erection, please see your GP as he or she will be able to discuss treatment to improve the quality of erections and help improve your sex life. 7

8 What will I need when I leave hospital after my surgery? Please ask the nurse looking after you if you require any of the following: l Copy of discharge letter l Supply of medication and instructions for use l Westfield claim form/private health care claim form l Contact number for Ward or Department l Transport (restrictions apply) l Details of follow up appointments l District Nurse visit Most patients are able to go home the day after their surgery and will be sent an appointment to be seen in the Andrology Clinic 4 to 6 weks later. Will I have to come back to hospital? You will either be contacted by telephone, or be sent an outpatient appointment. If you have any problems during the first 7 days after leaving hospital, please contact the Urology ward. After the first 7 days, please contact your own GP or NHS Direct. To speak to the Clinical Nurse Specialist, or Clinical Nurse Practitioner for urology, please telephone

9 Where to get help Men s Health Forum Tavistock House Tavistock Square London WC1H 9HR Telephone Men s Health Trust PO Box 195 Bury St. Edmunds Suffolk IP31 3NQ Prostate Help Association Langworth Lincoln LN3 5DF Prostate Research Campaign UK 36 The Drive Northwood Middlesex HA6 1HP Prostate Cancer Charity 3 Angel Walk Hammersmith London W6 9HX Telephone Imperial Cancer Research Fund PO Box 123 Lincoln s Inn Fields London WC2A 3PX Telephone In all cases, please send a large SAE when writing for information. 9

10 Useful contact numbers NHS Direct Telephone Patient Services Telephone Health Info Telephone Stop Smoking Service Telephone A&E Telephone For GP out of hours, contact your surgery 10 Useful websites If you require this document in another language, large print, braille or audio version, please contact Patient Information on Produced by the Department of Urology Nurses, February 2005 Revised August 2005, March 2009, September 2011 Revision due September Version: 4.0 The Rotherham NHS Foundation Trust All rights reserved.

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