Prostate surgery- TURP, laser surgery and UroLift

Benign prostatic hyperplasia (BPH) is an enlargement of the prostate gland. The word “benign” means the cells are not cancerous while “hyperplasia” indicates an increased number of prostate cells.

The prostate gland sits between the bladder neck and urinary sphincter and it encircles the urethra. It is common for the prostate gland to enlarge as a man ages and this results in significant urinary tract symptoms such as urinary frequency, urgency, weak stream, and nocturia (waking up at night to go to the bathroom). In severe cases, BPH will lead to frequent bladder infections, bladder stone formation, urinary retention, and renal failure.

Transurethral resection of the prostate (TURP) gland is carried out primarily to relieve obstruction, improve quality of life, and treat any complications of BPH such as regular bleeding, urinary tract infections, renal impairment, and bladder stones. This operation is different from the type of operation that is usually carried out in the treatment of prostate cancer.

The operation is performed by passing a telescopic instrument through the eye of the penis and down the urethra into the area of the prostate. The internal lining of the bladder is also routinely inspected. A special electric knife (or laser fiber) is used to cut (or vaporize) pieces of the prostate out and these pieces can then be flushed out. At the end of the procedure, a catheter (a plastic tube that drains urine from the bladder) is placed and usually kept in place from anything between one to three days after the surgery.

Whilst the catheter is in place, irrigating fluid can be instilled at the same time as the urine drains into a bag. The nurses will change the irrigating fluid and bag at regular intervals.

The operation takes on average around 45-60 minutes to perform and the usual length of stay in the hospital is around 1-2 days.

What are the main advantages of laser over The conventional TURP approach?

• Minimal invasive prostate surgery
• Safe in a patient taking blood thinning medication

What are the main disadvantages of laser over The conventional TURP approach?

• Slightly higher cost
• Some patients report a longer period of dysuria (burning sensation) and urinary urgency

UroLift ® system treatment

More recently a new minimally invasive surgery for BPH has been introduced and it is called UroLift. It works by lifting or holding the enlarged prostate out of the way so that it no longer blocks the urethra. There is no cutting, heating, or removal of prostate tissue. The advantage of this new procedure is that it relieves your urinary symptoms without compromising your sexual function.

What preparation is required?

As TURP is performed under regional or general anaesthesia, you should have nothing to eat or drink for 6 hours prior to treatment. Regular medications can be taken with a sip of water with the exception of blood thinning agents (eg. warfarin, aspirin, clopidogrel) or non-steroidal anti-inflammatories which need to be stopped for 7-10 days. If you are having laser TURP, you may continue to take these blood thinning agents. A mid-stream urine (MSU) test is required to ensure the urine is sterile before treatment is undertaken.

What happens in the operating room?

You will meet your anesthetist prior to surgery who will take a thorough medical history. Your anesthetist will discuss with you the choice of anesthesia; namely spinal (regional) or general anesthetic.

TURP is considered a safe procedure. Specific complications involve:

• Bleeding requires a longer duration of urinary catheter or clot retention; it is uncommon for a patient to require a blood transfusion  
• Retrograde (or absence of) ejaculation- this refers to the absence of any fluid when you have a sexual orgasm
• Infection
• Irritative urinary symptoms namely urinary frequency, urgency, and temporary urinary incontinence

What to expect after Surgery?

It is critically important to avoid any activity that involves straining or exertion for at least four weeks. Such activities include heavy lifting (for example, grocery shopping, picking up children etc). During this time you should not mow the lawn or play any sports that may involve some exertion such as golf or tennis.

You may resume driving a motor vehicle after two weeks. You should initially commence this with small trips and you should avoid any long car trips for at least four weeks.

You should try to have plenty of fiber in your diet and should you experience any problems with constipation, it is critically important that you do not strain and if you require help, you should see your pharmacist or family doctor. You should avoid any sexual activity for the next four weeks. There is no restriction on walking.

Follow-up

You will have a follow-up appointment with Prof. Chung in 4-6 weeks.