Trans urethral resection of prostate (TURP) Information for patients Urology PROUD TO MAKE A DIFFERENCE SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST
What is the prostate? Only men have a prostate gland. It is located underneath the bladder and surrounds the tube (urethra) that men pass urine through. The main function of the prostate is to produce the fluid that nourishes sperm in the semen. Bladder Pubic bone Prostate Urethra Rectum What is a TURP? A TURP (Trans Urethral Resection of Prostate) is a procedure carried out under a general or spinal anaesthetic. A urological surgeon will remove part of the prostate using a fine telescopic instrument which is introduced into your urethra (tube draining urine out of the bladder). A cut through the skin is not normally necessary. page 2 of 12
Why might I need a TURP? As men grow older, the prostate gland begins to increase in size. For some men this only becomes a problem when they begin to have bothersome urinary symptoms which may include: Poor flow or interrupted stream on emptying the bladder of urine Recurrent urinary tract infections (UTI) Frequent visits to the toilet during the night to pass urine Feelings of incomplete emptying of the bladder Dribbling after passing urine Unable to pass any urine These symptoms may be due to the enlarged prostate constricting the urethral passageway and reducing the flow of urine. The size of the prostate enlargement varies from man to man, as do the urinary symptoms they may be experiencing. For some, the enlargement of the prostate gland is benign (non-cancerous) and is considered to be a common occurrence amongst men as they age. An enlarged prostate is referred to as Benign Prostatic Hypertrophy (BPH). What are the alternative treatment options? Treatment options can include: Drugs Use of catheters Observation Your doctor will discuss these options with you. The rest of this leaflet will provide information on the TURP procedure. page 3 of 12
What are the risks of having a TURP? As with any procedure there are always risks to consider. Specific risks for TURP include: Common complications Temporary mild burning on passing urine Frequency of passing urine Light to moderate bleeding Retrograde ejaculation (where the sperm goes into the bladder on orgasm instead of coming out through the penis - there is more information on this further on in the leaflet) Occasional complications Poor erections, (impotence may happen in approximately 5-10% of men) Infection in your bladder or kidney Heavy bleeding requiring possible return to surgery or blood transfusion Possible need to repeat treatment due to re-growth of prostate in approximately 10% of men Bladder weakness requiring self-catheterisation to empty the bladder Failure to pass urine after surgery, requiring a new catheter Rare complications Scar tissue can form due to injury to your urethra Loss of urinary control (incontinence) which can be temporary or permanent Absorption of irrigation fluid used during your operation which can cause confusion or heart failure (TUR syndrome) Perforation of bladder requiring temporary urinary catheter or open surgery to repair page 4 of 12
Your doctor will discuss these risks with you before you are asked to give consent. What are the benefits of having a TURP? The main benefit of a TURP is that you pass urine a lot more easily with fewer potential problems to your urinary system. You should not need to go as frequently to the toilet to pass urine and you should be able to empty your bladder more fully. Preparing for your operation Pre-operative Assessment Clinic Before the operation you will be asked to attend the Pre-operative Assessment Clinic where tests may be carried out such as heart monitoring, blood tests and urine tests. You will be advised when to stop eating and drinking before your operation. Please ensure you have a list of your current medications for the pre-operative assessment nurses. You must inform staff if you are taking any anti-coagulation medication. As this operation can be undertaken using either a spinal or general anaesthetic, you may be advised at the pre-operative clinic which is most appropriate for you. Consent You will be asked to sign your consent form after being fully informed about the procedure. We must seek your consent for any procedure or treatment beforehand. Staff will explain the risks, benefits and alternatives where relevant before they ask for your consent. page 5 of 12
If you are unsure about any aspect of the procedure or treatment proposed please do not hesitate to ask for more information. The day of your operation What happens on the day of the operation? The nurse and the doctor in the Theatre Admissions Unit (TAU) will ask you information about yourself and about what you are expecting to happen. An anaesthetist may meet with you if they have not already done so in the pre-assessment clinic. Your operation will be explained to you and you will be asked to sign a consent form (if you have not already done this). The nurses in TAU will help you get ready for your TURP. How long will my operation take? Your operation may last up to an hour. What happens after the operation? You will be transferred to the urology ward. You may require oxygen following your operation. You may have an IV line (drip) that will remain in place until you are eating and drinking normally. Your blood pressure, temperature, pulse and respiration rate will be recorded by the nurse at regular intervals. You should be able to eat and drink normally once the anaesthetic has worn off. You will have a catheter in your bladder which will be draining blood stained urine into a large drainage bag. page 6 of 12
You will have irrigation fluid running through the catheter into your bladder to help to stop the bleeding. This may cause your catheter drainage bag to fill up quickly and need emptying regularly. The nurse will decide when the irrigation fluid can be removed. This is usually the day after your surgery as long as the bleeding has settled. Once it is removed, you will be encouraged to drink plenty of extra fluids to help your catheter to continue to flow. How should I expect to feel after the operation? You may experience some pain and discomfort after surgery. Pain very much depends on the individual; some men say they experience none or little pain but others do experience some pain or discomfort. Please inform the nurses who will ensure that you are given medication to alleviate this. You should be able to get out of bed later the same day or the next day. When will the catheter be removed? The doctor will decide when your catheter can be removed. Once your catheter is removed the nurses will then assess how well you are passing urine. This will need to be measured and recorded; the nurses will give you a bottle or a jug. As there is a slight risk of incontinence following this surgery you may be taught pelvic floor exercises for you to do once your catheter has been removed. page 7 of 12
Discharge from hospital Preparing to go home Your doctor and nurses will discuss with you when they are happy for you to go home. You may be given antibiotics; if so, you must ensure you complete the course. Make sure you have a supply of painkillers at home. If you require a sick note to cover your hospital stay, please ask the nurses on the ward. Any further sick notes can be obtained from your GP. Is there anything I should look out for at home? You may feel tired for a few weeks after the operation, but this will gradually improve. It can take up to 3 months before you are back to your usual self. Avoid constipation as straining can put pressure on the prostatic area and cause bleeding. If you feel unwell or feverish in the few days after discharge, contact the urology ward or urology outpatients for advice. You may be advised to contact your GP. Will I get a follow up appointment? Your consultant may arrange to see you in the outpatient department, although this is not always necessary until a few months after your procedure. When you come to the outpatient department you will need to perform a flow test. page 8 of 12
Frequently asked questions following a TURP Will I still get blood in my urine? You may still see some blood in your urine for at least 2-3 weeks following the operation and sometimes as long as 4-5 weeks. The prostate can take up to 6 weeks to heal. Around 10 days after the operation you may see some more blood in your urine; this is due to the scab falling off. If you do get blood in your urine, try to drink more fluids. If the bleeding continues to be heavy or if you are concerned please contact the urology ward or urology outpatients for advice. You may be advised to contact your GP. Discomfort on passing urine, having a temperature and excessive bleeding could be a sign of infection. Again if you are concerned, please contact the urology ward or urology outpatients for advice. You may be advised to contact your GP. Will I notice an immediate improvement in my urinary symptoms? Following the removal of the catheter you may experience some difficulty in controlling your urine and find you need the toilet more regularly. Be patient: staff will advise you on pelvic floor exercises to help control any dribbling you may be experiencing. It can take up to six months before you see the full benefit. Do I still need to drink plenty when I go home? Yes, until any bleeding settles, which should be within 2 to 3 weeks. Then drink 6-8 cups every day of any fluid e.g. tea, coffee, fruit juice, water. It is better not to drink too much after 6.00pm / 8.00pm to avoid having to go to the toilet in the night. page 9 of 12
You may drink alcohol in moderation after completing any course of antibiotics which may have been prescribed. Do I continue to take my tablets? Yes, unless your doctor has told you to stop. The ward staff will go through your medications with you on discharge. When you finish your supply of tablets you should return to your GP for further advice. If you have been on tablets for your urinary problems before the operation, you do not need to continue with these after your operation. If you have any questions please speak to the nurses before you leave hospital. Can I exercise? Only gentle exercise is recommended for the first 2-3 weeks. Avoid heavy lifting or straining. You can drive once you can perform an emergency stop without any discomfort, which is generally after 3 weeks. Can I go on holiday? There is no reason why you cannot go on holiday after the operation. Flights or long distance travelling is best left for 2-3 weeks. You must also inform your holiday insurance company that you have just had an operation. page 10 of 12
Can I have sex? It is best to wait 2-3 weeks following your operation before having sexual intercourse. After this time you should be able to enjoy a normal sex life. One very common consequence of the operation is 'retrograde ejaculation'. This means that when you have an orgasm nothing comes out of the penis. This is because the sperm is going back into the bladder instead of outwards in the usual way. It is a harmless side effect but it does mean that your fertility will be reduced, making it difficult to father children. A large number of people having a prostate operation suffer this side effect. Have I got cancer? Most enlarged prostates are not due to cancer. When you have the operation a specimen is always routinely sent to test for cancer. The results of this can take up to 10-14 days so it is most likely you will have been discharged before we receive it. We will write to your GP with the results. If you are worried or have problems after your discharge, please contact the urology ward or your GP. Who should I contact if I have any questions? If you have any concerns or questions please contact the Urology department on the following numbers: Urology Outpatients 0114 271 2343 (Mon - Fri, 8.30am - 8.30pm) Urology Admissions Unit 0114 226 5149 (24 hours) page 11 of 12
Produced with support from Sheffield Hospitals Charity Working together we can help local patients feel even better To donate visit www.sheffieldhospitalscharity.org.uk Registered Charity No 1169762 Alternative formats can be available on request. Please email: alternativeformats@sth.nhs.uk Sheffield Teaching Hospitals NHS Foundation Trust 2019 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD7570-PIL3101 v3 Issue Date: February 2019. Review Date: February 2021